低剂量奈达铂联合放疗治疗中晚期食管癌的疗效与安全性的Meta分析  

Meta-analysis of Efficacy and Safety of Low-dose Nedaplatin Combined with Radiotherapy for Moderate and Advanced Esophageal Cancer

作　　者：张质钢[1,2] 王小虎[1,2,3] 张秋宁[3] 王道英[1,2] 

机构地区：[1]兰州大学循证医学中心,兰州730000 [2]兰州大学第一临床医学院,兰州730000 [3]甘肃省肿瘤医院,兰州730050

出　　处：《中国药房》2013年第28期2657-2661,共5页China Pharmacy

摘　　要：目的:系统评价低剂量奈达铂联合放疗治疗中晚期食管癌的疗效和安全性。方法:计算机检索PubMed、Cochrane Library、EMbase、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库、万方数据库,检索时间为建库至2012年9月15日,同时辅以其他检索,纳入低剂量奈达铂(每周≤40mg/m2)联合放疗治疗中晚期食管癌的随机对照试验(RCT),对纳入研究进行资料提取和质量评价后采用RevMan5.1统计学软件进行Meta分析。结果:共纳入10项RCT,合计632例患者。Meta分析结果显示,与单纯放疗比较,低剂量奈达铂联合放疗可以显著提高中晚期食管癌患者的近期疗效[RR=1.39,95%CI(1.26,1.53),P<0.01]、近期完全缓解率[RR=1.91,95%CI(1.52,2.40),P<0.01],并可显著提高1年[RR=1.28,95%CI(1.05,1.56),P=0.01]、2年[RR=1.84,95%CI(1.27,2.66),P<0.01]和3年生存率[RR=1.81,95%CI(1.06,3.07),P=0.03]。但奈达铂组患者骨髓抑制较严重,且放射性食管炎发生率显著增加[RR=1.15,95%C(I1.03,1.28),P=0.01],与单纯放疗组比较差异有统计学意义。结论:低剂量奈达铂联合放疗可显著提高中晚期食管癌患者的近、远期疗效,但同时加重骨髓抑制,增加放射性食管炎的发生率,临床应用中应密切观察。OBJECTIVE： To evaluate the efficacy and safety of low-dose nedaplatin combined with radiotherapy for moderate and advanced esophageal cancer. METHODS： We searched PubMed, Cochrane Library, EMbase, CBM, CNKI, VIP, Wanfang databases until Sept. 15, 2012. Additional search was conducted. Randomized controlled trials （RCT） about low-dose nedaplatin （each week〈40 mg/m2） combined with radiotherapy for esophageal cancer were included. Meta-analysis of included literatures was conducted using Rev Man 5.1 software after information extraction and quality evaluation. RESULTS： 10 RCTs were included, in- volving 632 patients. Meta-analysis showed that nedaplatin combined with radiotherapy could significantly improve short-term effec- tive rate [RR= 1.39, 95% CI （1.26, 1.53）, P〈0.01] and short-term complete response rate [RR= 1.91, 95% CI （1.52,2.40）, P〈 0.01], compared with chemotherapy alone. And it significantly improved 1 year survival rates [RR= 1.28,95% CI（1.05,1.56）, P= 0.01], 2 years survival rates [RR=1.84,95%CI（1.27,2.66）, P〈0.01], 3 years survival rates [RR=1.81,95%CI（1.06,3.07）, P： 0.03]. The arrest of bone marrow was severe in nedaplatin group, and the incidence of radiation esophagitis was increased [RR： 1.15, 95% CI （1.03, 1.28）, P：0.01] significantly; there was statistical significantly between nedaplatin group and chemotherapy alone group. CONCLUSIONS： Low-dose nedaplatin combined with radiotherapy can improve long-term and short-term efficacy in patients with moderate and advanced esophageal cancer. However, nedaplatin aggravate myelosuppression and improve the radiation esophagitis rate, which should be closely observed in the clinic.

关 键 词：食管癌 放疗 增敏 奈达铂 META分析 

分 类 号：R735.1[医药卫生—肿瘤]