食管癌术后辅助化疗的荟萃分析和来自复旦大学附属肿瘤医院的配对研究  

Adjuvant chemotherapy in esophageal cancer:a meta-analysis and experience from Cancer Hospital,Fudan University

作　　者：张杰 陈海泉[1] 张亚伟[1] 周晓燕[2] 沈盛萍[3] 胡鸿[1] 缪龙升[1] 李鹤成[1] 马龙飞[1] 相加庆[1] 

机构地区：[1]复旦大学附属肿瘤医院胸外科,复旦大学上海医学院肿瘤学系,上海200032 [2]复旦大学附属肿瘤医院病理科,复旦大学上海医学院肿瘤学系,上海200032 [3]上海交通大学附属胸科医院肺部肿瘤临床医学中心,上海200030

出　　处：《中国癌症杂志》2008年第4期276-281,共6页China Oncology

基　　金：复旦大学附属肿瘤医院影像学基金(YX200602);中国博士后基金(20070410733)

摘　　要：背景与目的:目前关于食管癌的辅助化疗的前瞻性随机临床试验很少。本研究的目的是通过荟萃分析,并结合复旦大学附属肿瘤医院的资料,明确食管癌术后辅助化疗的价值。方法:荟萃分析使用Comprehensive meta-analysis软件。配对研究包括1998—2004年在复旦大学附属肿瘤医院接受治疗的食管癌患者,其中90名患者接受辅助化疗,180名患者未接受化疗。采用免疫组化的方法检测了9个标志物分析预后和预测化疗价值。结果:共有6项研究,1037例患者纳入本荟萃分析,接受辅助化疗与未化疗组治疗效果差异无显著性,而在淋巴结有转移的亚组患者中,辅助化疗显示了提高生存率的趋势。来自复旦大学附属肿瘤医院的研究中,未化疗组和化疗组的Ⅰ期患者(P=0.59&P=0.59)、Ⅱ期患者(P=0.2778&P=0.2778)及Ⅲ期患者(P=0.695&P=0.8667)无病生存率和总生存率差异无显著性。化疗对肿瘤转移至喉返神经和(或)腹腔淋巴结的患者(Ⅳa亚组)最有效。无病生存率和总生存率明显优于未接受化疗的患者(P=0.038,0.01)。Bcl-2表达提示预后不良,其在化疗组中的表达较无化疗组更有预测意义。结论:辅助化疗能明显提高Ⅳa期(远处淋巴结转移)患者治疗效果。Bcl-2是分析预后及指导辅助治疗的潜在分子标志物。尽管我们是目前文献报道最大样本的食管癌化疗研究,但结论还需要前瞻性的临床试验验证。Background and purpose： Whether adjuvant chemotherapy can increase the survival of esophageal cancer patients has been greatly debated . The existed meta-analysis about adjuvant chemotherapy in esophageal cancer only included 3 clinical trials, and was published several years ago. There has been renewed enthusiasm for investigations of it to reconcile this conflict of evidence. Methods： All available studies up to July 2007 were combined using comprehensive meta-analysis software. For our study, between 1998 and 2004, 90 esophageal cancer patients with adjuvant chemotherapy, and well- matched 180 patients without chemotherapy, were included. To analyze the prognostic and predictive significance for molecular markers in esophageal cancer, nine markers were measured in the protein level by immunohistochemical staining. Results： From current meta analysis, adjuvant chemotherapy did not improve the outcome of esophageal cancer patients（ 95% CI, 0741-1. 246, P = 0. 763）. A trend of better outcome from adjuvant chemotherapy in lymph node positive patients was detected, but the difference still did not reach significance （95% CI 0. 538-1. 083, P = 0.13）. In our own study cohort including 270 patients, adjuvant chemotherapy did not improve the survival of the whole group of patients, but did improve the survival for the patients who had metastases in cervical and/or celiac lymph nodes （Ⅳa subgroup）. Among the factors evaluated, Bcl-2 expression was a worse prognostic factor, and was more predictive in adjuvant chemotherapy group than no chemotherapy group. Conclusions： Though our study has biggest patient sample compared with other studies published , more prospective clinical trials with big samples are still necessary to confirm the value of adjuvant chemotherapy in Ⅳa subgroup patients, and the significance of Bcl-2 expression in predicting prognosis and treatment efficacy.

关 键 词：食管癌 辅助化疗 荟萃分析 分子标志物 

分 类 号：R735.1[医药卫生—肿瘤]