摘要
目的食管癌患者就诊时大多属中晚期,单纯手术疗效不佳,需结合放化疗提高疗效,但手术与放化疗治疗顺序备受争议。本研究通过对比中晚期可切除食管癌术前与术后放化疗2种治疗模式的疗效及安全性,探寻治疗食管癌的有效治疗模式,为指导临床实践提供理论依据。方法计算机检索The Cochrane Library、Embase、PubMed、Web of Science、CBM和CNKI,同时辅佐其他检索途径,检索2016-10前所有关于对比食管癌术前放化疗与术后放化疗的临床研究。随机对照研究(randomized controlled trial,RCT)采用Cochrane质量评价标准评价文献质量,非随机对照研究采用纽斯卡尔-渥太华量表(newcastle-ottawa scale,NOS)质量评价标准评价文献质量,统计学分析采用Review Manager5.3软件。本Meta分析遵循系统综述与荟萃分析优先报告条目(PRISMA)规范。结果共纳入1个RCT和5个非随机对照研究,Meta分析结果显示,1年生存率(OR=1.24,95%CI:0.96~1.61,P=0.09)、3年生存率(OR=1.25,95%CI:1.00~1.55,P=0.05)、5年生存率(OR=1.39,95%CI:0.93~2.06,P=0.11)和术后并发症发生率(OR=1.45,95%CI:0.81~2.60,P=0.21)差异均无统计学意义。亚组分析显示,国内人群1年生存率(OR=1.30,95%CI:0.48~3.58,P=0.61)、国外人群1年生存率(OR=1.37,95%CI:0.79~2.38,P=0.26)、国内人群3年生存率(OR=1.16,95%CI:0.90~1.49,P=0.25)和国外人群3年生存率(OR=1.55,95%CI:1.00~2.41,P=0.05)差异均无统计学意义。结论中晚期可切除食管癌术前放化疗与术后放化疗疗效及安全性相似,临床上可酌情考虑后决定手术与放化疗治疗顺序,但仍有待大量多中心、前瞻性随机对照临床实验证实。
OBJECTIVE Patients with esophageal cancer are most commonly diagnosed with locally advanced tumor stages.The efficacy of surgery alone for patients with locally advanced esophageal cancer is still unsatisfactory.Conbine with chemoradiation is commonly pursued in patients with locally advanced disease.However,the sequence of chemoradiation and surgery in patients with resectable locally advanced esophageal cancer remains controversial.To seek a more effective treatment for locally advanced esophageal cancer,and provide theoretical basis for clinical treatment,a meta-analysis of clinical trials directly comparing preoperative chemoradiation versus postoperative chemoradiation to evaluate the effectiveness and safety of the two treatment choices in locally advanced esophageal cancer patients was performed.METHODS A meta-analysis was performed using trials identified through The Cochrane Library,Embase,PubMed,Web of Science,CBM,CNKI,as well as other auxiliary retrieval,and collected all of the trials about preoperative chemoradiation versus postoperative chemoradiation in locally advanced esophageal cancer.The quality of study about randomized controlled trial（RCT）was evaluated with Cochrane quality standards,while nonrandomized clinical trials was evaluated with Newcastle-Ottawa Scale（NOS）,and statistical analysis was performed using Review Manager 5.3software.This article was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses（the PRISMA statement）.RESULTS 1RCT and 5nonrandomized clinical trials were analyzed in the study.Meta-analysis showed that：1-year survival rate（OR=1.24,95%CI：0.96-1.61,P=0.09）、3-year survival rate（OR=1.25,95%CI：1.00-1.55,P=0.05）,5-year survival rate（OR=1.39,95%CI：0.93-2.06,P=0.11）,surgical complication rate（OR=1.45,95%CI：0.81-2.60,P=0.21）;there were no differences between two arms.Subgroup analysis showed that：1-year survival rate in Chinese（OR=1.30,95%CI：0.48-3.58,P=0.61）、1-year survival rate in foreigners（OR=1.37,95%CI：0.79-2.38,P=0.26）,3-year survival rate in Chinese（OR=1.16,95%CI：0.90-1.49,P=0.25）,3-year survival rate in foreigners（OR=1.55,95%CI：1.00～2.41,P=0.05）,there were no differences between two arms.CONCLUSIONS The effectiveness and safety were similar between chemoradiation followed by surgery and surgery followed by chemoradiation in locally advanced esophageal cancer,we can select the sequence of chemoradiation and surgery individual in clinical according to the actual situation.But further comparison of preoperative chemoradiation versus postoperative chemoradiation in treating locally advanced esophageal cancer is required for verification through multicenter and large sample randomized clinical trials.
出处
《中华肿瘤防治杂志》
CAS
北大核心
2017年第3期201-206,共6页
Chinese Journal of Cancer Prevention and Treatment
关键词
食管癌
术前放化疗
术后放化疗
META分析
esophageal cancer
preoperative chemoradiation
postoperative chemoradiation
meta-analysis
