新辅助化疗与初始肿瘤细胞减灭术治疗晚期卵巢癌疗效的系统评价  

Neoadjuvant chemotherapy versus primary debulking surgery in the treatment of advanced- stage ovarian cancer:a systematic evaluation

作　　者：杨利娟[1] 张波[2] 杨永秀[3] 

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第二医院骨一科,甘肃兰州730000 [3]兰州大学第一医院,甘肃兰州730000

出　　处：《中国实用妇科与产科杂志》2017年第2期171-176,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家自然科学基金(81450042)

摘　　要：目的系统评价新辅助化疗与初始肿瘤细胞减灭术在晚期卵巢癌患者中的疗效。方法计算机检索Pub Med、EMbase、Cochrane library、Web of Science、CBM、Google Scholar等数据库,检索时限均从建库至2015年7月,两名研究者依据纳入和排除标准独立筛选文献和提取数据,参照Cochrane系统评价手册5.1.0和NOS(Newcastle-Ottawa Scale)评分分别进行质量评价,并行Meta分析。结果最终纳入3篇高质量随机对照试验(RCT)和4篇前瞻性研究,共2476例患者。对RCT研究进行Meta分析结果显示:新辅助化疗与初始肿瘤细胞减灭术相比,总生存期延长(P<0.001),肿瘤细胞减灭术满意率增高(P<0.001),术后28 d内病死率降低(P=0.002),而无进展生存期(P=0.32),随访6个月(P=0.51)和12个月(P=0.89)的生存质量差异无统计学意义。对前瞻性研究行Meta分析结果显示:新辅助化疗与初始肿瘤细胞减灭术相比,无进展生存期缩短(P<0.001),肿瘤细胞减灭术满意率升高(P<0.001),而手术时间(P=0.84)和住院时间(P=0.23)差异无统计学意义。结论与初始肿瘤细胞减灭术相比,新辅助化疗可延长晚期卵巢癌患者的总生存期,提高肿瘤细胞减灭术满意率,减少术后病死率。此结论尚需更多多中心、高质量的随机对照试验证实。Objective To compare the effectiveness of neoadjuvant chemotherapy with that of primary debulking surgery in the treatment of advanced stage ovarian cancer. Methods A systematic search was conducted through Pub Med,Embase,Cochrane library,Web of Science,CBM,Google Scholar from database inception to July 2015. According to the inclusion criteria,two reviewers worked respectively to screen the included studies followed by data extraction. The quality assessment of the included studies were performed according to the Cochrane Collaboration Risk Assessment Tool and Newcastle-Ottawa Scale（NOS）. Results Three eligible RCTs and four prospective studies involving 2476 participants were included. When compared with primary debulking surgery,Meta-analysis of three included RCTs demonstrated that neoadjuvant chemotherapy provided significantly better overall survival（OS）（P〈0.001）,a higher optimal cytoreduction rate（residual disease〈1 cm）（P〈0.001）,significantly fewer postsurgical mortalities within 28 days of surgery（P=0.002）,but progression-free survival and quality of life at 6/12 months were similar. Meta-analysis of four prospective studies demonstrated that neoadjuvant chemotherapy provided worse progression- free survival（P〈0.001）,a greater chance of achieveing optimal cytoreduction（P〈0.001）than primary surgery,but the operative time and duration of hospitalization were similar between the two groups. Conclusion Neoadjuvant chemotherapy provides improved OS,higher optimal cytoreduction rate and fewer mortalities within 28 days after surgery when compared with primary debulking surgery. This conclusion needs to be confirmed by more multicenter and high-quality random control trials.

关 键 词：卵巢肿瘤 新辅助化疗 肿瘤细胞减灭术 系统评价 

分 类 号：R737.3[医药卫生—肿瘤]