直肠癌新辅助治疗后临床完全缓解患者不同处理措施预后效果的Meta分析  

Complete clinical response after neoadjuvant therapy in rectal cancer:a Meta-analysis of prognosis

作　　者：李俊[1] 崔健[1] 张海增[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院腹部外科,北京100021

出　　处：《中国肿瘤外科杂志》2014年第2期69-76,共8页Chinese Journal of Surgical Oncology

摘　　要：目的 直肠癌新辅助治疗后临床完全缓解患者不同处理措施预后效果的Meta分析 目的 以Meta分析评价针对新辅助治疗后达临床完全缓解的直肠癌患者行根治性手术、局部切除以及非手术临床观察的效果，为临床决策提供临床依据。方法 以“rectal cancer”、“rectal adenocarcinoma”、“rectal neoplasms”、“neoadjuvant therapy”、“preoperative therapy”、“radiochemotherapy”、“radiotherapy”、“clinical complete response”、“complete pathological response”为主题词，在PubMed上收集有关直肠癌临床完全缓解患者进行根治性手术、局部切除和非手术治疗临床观察的公开发表的英文文献。纳入局部切除与根治性手术预后情况对比文献5篇，非手术临床观察与局部切除对比文献5篇。经两名研究者独立提取相关数据资料后进行Meta分析，用定性方法比较各预后指标在非手术组与根治性手术组、局切组与根治性手术组间的差异。利用Begg秩相关法评价发表偏倚。 结果 定性分析结果显示，与根治性手术组相比，非手术治疗临床观察组局部复发RR=5.33，95%CI为1.64-17.36，总复发RR=2.37，95%CI为1.15-4.85，差异有统计学意义；但远处转移率（RR=0.87, 95%CI： 0.16-41.11）及3-5年总生存率（RR=0.89, 95%CI： 0.66-1.21）无统计学差异。与根治性手术组相比，局部切除组局部复发率（RR=1.25, 95%CI： 0.64-2.44）、远处转移率（RR=0.55, 95%CI： 0.27-1.10）及总复发率（RR=0.77, 95%CI： 0.49-1.22）均无统计学差异，且5年总生存率局部切除组界值性高于根治性手术组（P〈0.05）。结论 直肠癌新辅助治疗后达临床完全缓解患者行非手术观察的局部复发率、总复发率高于根治性手术，但远处转移、长期生存与根治性手术相比无显著差异。局部切除术的局部复发率、远处转移率与根治性手术相比无显著差异，行局部切除者术长�Objective To evaluate the prognosis of treatments of radical surgery, local excision and non- surgical clinical observation for rectal cancer patients who received neoadjuvant therapy and had complete clini- cal response, and provide evidence-based data for clinical research and treatment. Methods A Meta-analysis was performed to evaluate the prognosis effect of different clinical treatments on rectal cancer by considering the heterogeneity of major related parameters including publication calendar period and chemotherapy regimes. Med- line was employed to search for citations published from January 1989 to August 2010 using the MeSH terms ＂rectal cancer＂, ＂rectal adenocarcinoma＂, ＂rectal neoplasms＂, ＂neoadjuvant therapy＂,＂ neoadjuvant chemo- radiotherapy＂, ＂preoperative therapy＂, ＂radiochemotherapy＂, ＂radiotherapy＂, ＂clinical complete response＂ and ＂complete pathological response＂. Additional relevant references cited in retrieved articles were also evaluated. Finally, total of 10 articles were found to be about prognosis evaluation on radical surgery, local excision and non-surgical clinical observation for subjects with rectal cancer and have had clinical complete response, a- mong which 5 articles were about comparison between local excision and radical surgery, and another 5 articles were about the comparison between non-surgical clinical observation and local excision. Two investigators inde- pendently extracted the data and reached the consensus on all items. For each included study, the following in- formation were extracted ： first author＇ s name, journal and year of publication, country of origin, sample size, number of cases of radical surgery, local excision and non-surgical clinical observation, sex ratio, mean or me- dian age, radiotherapy and radiochemotherapy programs, numbers of distant metastasis, 3-5 years survival ca- ses, and the disease-free survival cases among these three groups, overall numbers of subjects with disease stage. The quantitative me

关 键 词：直肠癌 临床完全缓解 新辅助治疗 根治性手术 局部切除 非手术治疗 

分 类 号：R735.37[医药卫生—肿瘤]