TPF或PF方案诱导化疗治疗局部晚期头颈鳞癌的Meta分析  

Induction Chemotherapy with Cisplatin and Fluorouracil alone or with Taxanes for Locally Advanced Squamous-Cell Cancer of the Head and Neck:A Meta-Analysis

作　　者：廖恺[1] 毕卓菲[1] 何艳[1] 刘宜敏[1] 

机构地区：[1]中山大学孙逸仙纪念医院放疗科,广州510120

出　　处：《循证医学》2012年第5期278-285,共8页The Journal of Evidence-Based Medicine

摘　　要：目的通过Meta分析,比较紫杉类+顺铂+氟尿嘧啶与顺铂+氟尿嘧啶诱导化疗治疗局部晚期头颈鳞癌的疗效和安全性。方法通过MEDLINE、EMBASE、Cochrane图书馆、CBM等数据库检索国内外已发表和未发表的相关文献。选择治疗组为紫杉类+顺铂+氟尿嘧啶诱导化疗,对照组为顺铂+氟尿嘧啶诱导化疗的局部晚期头颈鳞癌的随机对照研究。由2位评价者分别按上述检索策略收集资料,按纳入、排除标准入选,对总生存期、无进展生存期、完全缓解率、客观缓解率及毒性反应等进行Meta分析。结果共纳入4个随机对照研究。紫杉类+顺铂+氟尿嘧啶诱导化疗与顺铂+氟尿嘧啶诱导化疗相比,前者的总生存期(风险比0.76,P=0.0001)、无进展生存期(风险比0.73,P<0.00001)、完全缓解率(危险比1.5,P=0.03)、客观缓解率(危险比1.2,P<0.00001)均显著优于后者;在毒性反应方面,除3/4度中性粒细胞减少的发生率前者高于后者外,其余3/4度血液学毒性和3/4度消化道毒性的发生率两者相当或是前者低于后者。结论目前证据表明,紫杉类+顺铂+氟尿嘧啶诱导化疗与顺铂+氟尿嘧啶诱导化疗相比,显示了更优的疗效及安全性,可作为局部晚期头颈鳞癌诱导化疗的一线选择。Objective To compare the antitumor activity and toxicity of two induction chemotherapy treatments of Taxanes, Cisplatin and Fuorouracil （TPF） versus Cisplatin and Fluorouracil （PF） in locally advanced squamous-eell cancer of the head and neck through a meta-analysis. Methods All previously published and some unpublished studies were performed with a comprehensive search of the literatures included in MEDLINE, EMBASE, Cochrane Library, CBM, etc. The meta-analysis included all randomized controlled trials （RCTs） to compare induction chemotherapy treatments of TPF as experiment group, with PF as control group, in locally advanced squamous-cell cancer of the head and neck. The meta-analysis was based on overall survival（OS）, progression-free survival（PFS）, complete remission （CR） rate, objective remission （OR） rate and toxicity. Results Four RCTs identified by two reviewers were included. There was a significant improvement for the TPF group in OS（HR=0.76, P=0.000 1）, PFS （HR=0.73, P〈0.000 01）, CR rate （RR=1.5, P=0.03） and OR rate（RR=1.2, P〈0.000 01）. In terms of toxicity, except that incidence of ncutropenia in TPF group was higher than PF group, the other haematological toxicity andgastrointestinal toxicity were the same between two groups, or TPF group was lower than PF group. Conclusion Current available evidence shows that both efficacy and safety of induction chemotherapy of TPF are superior to PF and the former one could be a first-line choice for the induction chemotherapy treatment in locally advanced squamous- cell cancer of the head and neck.

关 键 词：局部晚期头颈鳞癌 顺铂 氟尿嘧啶 紫杉类 诱导化疗 META分析 

分 类 号：R739.91[医药卫生—肿瘤]