多西他赛化疗联合放疗治疗食管癌疗效的系统评价  

Clinical effects of docetaxel chemotherapy combined with radiotherapy in the treatment of esophageal cancer: A systematic review

作　　者：胡学军[1] 张虎 邵国安[1] 王尚前[1] 刘贵峰[1] 王洛昆[1] 徐永耀[1] 

机构地区：[1]新疆医科大学第五附属医院肿瘤中心,新疆维吾尔自治区乌鲁木齐市830011

出　　处：《世界华人消化杂志》2012年第33期3256-3265,共10页World Chinese Journal of Digestology

摘　　要：目的:评价多西他赛化疗联合放疗与单纯放疗治疗食管癌的有效性及安全性.方法:计算机检索CBM(1978-2011)和CNKI(1979-2011)并手工检索发表的资料和会议论文并追索纳入文献的参考文献,查找国内比较多西他赛化疗联合放疗与单纯放疗治疗食管癌的相关病例-对照试验.对纳入研究进行方法学质量评价之后,采用RevMan5.1软件进行Meta分析.结果:共纳入6个国内相关病例-对照研究,合计378例患者.Meta分析结果表明:与单纯放疗治疗食管癌相比,多西他赛化疗联合放疗提高完全缓解率[RR=2.12,95%CI(1.39,3.25),P=0.0005],提高近期治疗有效率[RR=3.56,95%CI(1.97,6.42),P<0.0001]及1年生存率[RR=2.64,95%CI(1.17,5.97),P=0.02],并明显缓解食管黏膜1级反应[RR=0.37,95%CI(0.17,0.80),P=0.01].而在部分缓解率[RR=1.05,95%CI(0.69,1.59),P=0.83]、3年生存率比较[RR=2.21,95%CI(1.16,4.22),P=0.02]、消化道反应0、1、2、3级[RR=0.78,95%CI(0.35,1.73),P=0.55;RR=2.05,95%CI(0.92,4.59),P=0.08;RR=1.08,95%CI(0.49,2.39),P=0.84;RR=1.45,95%CI(0.54,3.90),P=0.46]、血液毒性[RR=0.55,95%CI(0.26,1.13),P=0.10;RR=1.00,95%CI(0.48,2.10),P=1.00;RR=1.26,95%CI(0.58,2.74),P=0.56;RR=1.29,95%CI(0.48,3.51),P=0.61;RR=3.09,95%CI(0.31,30.50),P=0.33]、食管黏膜反应2、3级[RR=1.20,95%CI(0.60,2.39),P=0.60;RR=1.27,95%CI(0.49,3.30),P=0.63]等方面没有显著性差异.结论:多西他赛化疗联合放疗治疗食管癌的有效性及安全性总体疗效明显优于单纯放疗.由于纳入研究数量少,上述结论尚需开展更多设计合理的多中心大样本的随机对照试验加以验证.AIM： To compare the efficacy and safety of docetaxel chemotherapy combined with radio- therapy versus radiotherapy only in the treat- ment of esophageal cancer. METHODS： Controlled trials that evaluated clini- cal effects of docetaxel chemotherapy combined with radiotherapy versus radiotherapy alone in the treatment of esophageal cancer were elec- tronically searched from the CBM （1978-2011） and CNKI （1979-2011） databases, and the relevant published and unpublished data and their refer- ences in Chinese were also searched manually. The data were extracted and the methodologicalquality of the incorporated research was evaluat- ed by two reviewers independently. The RevMan 5.1 software was used for meta-analysis. RESULTS： Ten controlled trials involving 378 patients were included. Meta-analysis showed that compared with radiotherapy alone, docetax- el chemotherapy combined with radiotherapy was associated with better complete remission [RR = 2.12, 95%confidenceinterval （CI） （1.39, 3.25）, P = 0.0005], short-term efficacy [RR = 3.56, 95%CI （1.97, 6.42）, P 〈 0.0001], 1-year survival rate [RR = 2.64, 95%CI （1.17, 5.97）, P = 0.02], and significantly improved grade 1 gastrointestinal reactions [RR = 0.37, 95%CI （0.17, 0.80）, P = 0.01]. There were no significant differences in the rate of partial remission [RR = 1.05, 95%CI （0.69, 1.59）, P = 0.83], 3-year survival rate [RR = 2.21, 95%CI （1.16, 4.22）, P = 0.02], grades 0, 1, 2 and 3 gastrointestinal reactions [RR = 0.78, 95%CI （0.35, 1.73）, P=0.55; RR = 2.05, 95%CI （0.92, 4.59）, P = 0.08; RR = 1.08, 95%CI （0.49, 2.39）, P = 0.84; RR = 1.45, 95%CI （0.54, 3.90）, P = 0.46], grades 0, 1, 2, 3 and 4 hematologic toxicities [RR = 0.55, 95%CI （0.26, 1.13）, P = 0.10; RR = 1.00, 95%CI （0.48, 2.10）, P = 1.00; RR = 1.26, 95%CI （0.58, 2.74）, P = 0.56; RR = 1.29, 95%CI （0.48, 3.51）, P = 0.61; RR =3.09, 95%CI （0.31, 30.50）, P = 0.33], and grades 2 and 3 esophageal mucosal reactions [RR = 1.20, 95%CI （0.60, 2

关 键 词：多西他赛 放化疗联合 食管癌 对照试验 系统评价 Meta分析 

分 类 号：R735.1[医药卫生—肿瘤]