进展期直肠癌术前联合放化疗中奥沙利铂作用的meta分析  

Role of oxaliplatin in preoperative of advanced rectal cancer:a meta-analysis

作　　者：李志艳[1] 张小燕[1] 唐海林[2] 吴清[1] 

机构地区：[1]南华大学附属南华医院消化内科,衡阳湖南421002 [2]中山大学附属肿瘤防治中心乳腺科,广州广东510000

出　　处：《临床荟萃》2017年第1期74-77,共4页Clinical Focus

基　　金：国家自然科学基金资助项目(81472469)

摘　　要：目的探讨进展期直肠癌奥沙利铂术前放疗及卡培他滨联合治疗中应用奥沙利铂是否有其必要性及价值。方法通过pubmed、embase、中国知网、万方、维普等数据库及论文检索相关文献。试验组为卡培他滨联合组(放疗+卡培他滨+奥沙利铂),对照组为卡培他滨组(放疗+卡培他滨),进展期直肠癌的随机对照试验(randomized controlled trial,RCT)由两位研究者按上述检索策略收集资料,根据纳入标准筛选文献,主要对病理完全缓解、不良反应进行meta分析。结果根据文献纳入标准,从735篇文献中筛选出符合标准的4篇RCT,共2 066例,两组间病理完全缓解率(yp complete response,ypCR)差异无统计学意义(P=0.13),卡培他滨联合组的毒性反应发生率提高13%(95%CI=0.08~0.18,P<0.01),腹泻发生率提高9%(95%CI=0.06~0.12,P<0.01),乏力发生率提高4%(95%CI=0.02~0.06,P=0.0002)。两组间放射性皮炎及hand-foot综合征差异无统计学意义(P>0.05)。结论奥沙利铂不能明显改善ypCR,但增加了其不良作用。现有证据支持术前放疗及卡培他滨化疗为更佳治疗方案,但仍需更多高质量临床试验。Objective To explore the role of oxaliplatin combined with capecitabine in the preoperative of advanced rectal cancer.Methods A comprehensive search of literatures including Pubmed,Embase,China National Knowledge Infrastructure,Wanfang database and Vip database was performed.The meta-analysis included randomized controlled trial to compare neoadjuvant capecitabine plus radiation with or without oxaliplatin with respect to complete response and toxicities.Results Of 735 reports,four randomized controlled trials including 2 066 patients were identified by two reviewers.There was no statistically significant differences between capecitabine plus radiation with or without oxaliplatin in ypCR（P =0.13）.The CAPOX（radiation＋capecitabine＋oxaliplatin）group increased with13%in the toxicity（95%CI =0.08-0.18,P〈0.01）,increased with 9%in diarrhea（95%CI =0.06-0.12,P〈0.01）and increased with 4% in fatigue（95%CI =0.02-0.06,P =0.0002）in comparison with the CAP（radiation＋oxaliplatin）.No significant difference was observed in radiation dermatitis and hand-foot syndrome.ConclusionOxaliplatin does not improve the ypCR but increase considerable toxicities.Current evidence supports preoperative radiation plus capecitabine in the treatment of patients with rectal cancer,but still needs more high-quality clinical trials.

关 键 词：胃肿瘤 奥沙利铂 卡培他滨 放化疗 

分 类 号：R735.2[医药卫生—肿瘤]