Ⅱ、Ⅲ期直肠癌术前与术后放化疗疗效比较的Meta分析  

Comparison of preoperative and postoperative chemoradiotherapy for stage Ⅱ and Ⅲ rectal cancer:a meta-analysis

作　　者：蔡成[1] 王建平[1] 戴志慧[1] 王庆华[1] 杜金林[1] 

机构地区：[1]金华市中心医院结直肠肛门外科,321000

出　　处：《浙江医学》2016年第1期44-48,共5页Zhejiang Medical Journal

基　　金：金华市科学技术研究计划项目(2014-3-010)

摘　　要：目的通过Meta分析比较术前与术后放化疗对Ⅱ、Ⅲ期直肠癌的疗效。方法检索2014年12月前发表的有关Ⅱ、Ⅲ期直肠癌术前与术后放化疗疗效比较的文献,纳入本研究的文献为随机对照试验(RCT),提取其短期及长期临床疗效指标进行分析。结果共包括1 642例直肠癌患者的5项RCT纳入本研究。术前放化疗组患者较术后放化疗组5年局部复发率低(OR=0.60,95%CI:0.41～0.88,P=0.008),两组5年远处转移率(OR=0.87,95%CI:0.67～1.11,P=0.26)、5年无病生存率(HR=0.84,95%CI:0.70～1.00,P=0.05)及总生存率(HR=0.90,95%CI:0.75～1.08,P=0.27)比较均无统计学差异,术前放化疗组毒性反应发生率较术后放化疗组低(OR=0.64,95%CI:0.50～0.82,P<0.01)。结论采用术前放化疗的患者较术后放化疗的患者对直肠癌复发及毒性反应发生风险小,但远处转移及远期预后无明显差别。Objective To compare preoperative chemoradiotherapy （CRT） with postoperative CRT for patients with stage Ⅱ and Ⅲ rectal cancer through meta-analysis. Methods Medline, Cochrane Library, Web of Science, Ebsco and Ovid Electronic database were searched and only randomized controlled trials for patients with resectable stage Ⅱ and Ⅲ rectal cancer were included. Results Five clinical trials involving 1642 patients were included in meta-analysis. The results revealed that preoperative CRT improved local control （OR=0.60, 95% CI：0.41-0.88, P=0.008） compared to postoperative CRT and it might benefit for disease free survival （DFS） （HR=0.84, 95% CI：0.70-1.00, P=0.05）; whereas there were no significant differences in distant metastases rate （OR=0.87, 95% CI：0.67-1.11, P=0.26） and overall survival （OS）（HR=0.90, 95% CI：0.75-1.08, P=0.27） between two methods. Preoperative CRT was less toxicity than postoperative CRT （OR=0.64; 95% CI：0.50-0.82, P 〈0.01）. Conclusion Preoperative chemoradiotherapy can reduce local recurrence rate with less toxicity compared to postoperative CRT.

关 键 词：直肠癌 术前 术后 放化疗 

分 类 号：R735.37[医药卫生—肿瘤]