中晚期可切除食管癌术后放化疗与单纯手术对比的Meta分析  

Meta-analysis of postoperative chemoradiation versus surgery alone for locally advanced esophageal cancer

作　　者：张远净 吴双[1] 岳国军[1] 柏玉举[1] 马虎[1] 王荣桃[1] 李宁[1] ZHANG Yuanjing WU Shuang YUE Guojun BAI Yuju MA Hu WANG Rongtao LI Ning(Department of Chest Oncology, Tumor Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Chin)

机构地区：[1]遵义医学院附属医院肿瘤医院胸部肿瘤科,贵州遵义563000

出　　处：《中国医药导报》2017年第5期94-98,共5页China Medical Herald

基　　金：贵州省科技计划课题(黔科合SY字[2009]3055);贵州省科学技术基金项目(黔科合J字LKZ[2013]54)

摘　　要：目的对比中晚期可切除食管癌术后放化疗与单纯手术两种治疗模式的疗效及安全性,寻找更有效的治疗模式,为指导临床实践提供理论依据。方法计算机检索The Cochrane Library、Embase、PubMed、Web of Science、CBM、CNKI,同时辅佐其他检索途径,检索2016年10月20日前所有关于对比食管癌术后放化疗与单纯手术的随机对照实验(RCT)。采用Cochrane质量评价标准评价文献质量,统计学分析采用Review Manager 5.3软件。结果共纳入5个RCTs,Meta分析结果显示:1年生存率(OR=1.63,95%CI:1.17~2.28,P=0.004)、3年生存率(OR=2.18,95%CI:1.60~2.97,P<0.00001)、5年生存率(OR=2.08,95%CI:1.48~2.92,P<0.0001)、10年生存率(OR=2.20,95%CI:1.21~4.01,P=0.010)及局部复发率(OR=0.28,95%CI:0.18~0.43,P<0.00001),两组差异均有统计学意义,术后放化疗组优于单纯手术组;术后并发症发生率(OR=1.10,95%CI:0.61~1.97,P=0.75)、远处转移率(OR=0.75,95%CI:0.49~1.14,P=0.18),差异无统计学意义,两组相似。结论中晚期可切除食管癌术后放化疗疗效及安全性优于单纯手术治疗,但仍需多中心、大样本前瞻性随机对照实验证实。Objective To compare the effectiveness and safety of postoperative chemoradiation versus surgery alone for locally advanced esophageal cancer, find a more effective treatment mode, in order to provide theoretical basis for clinical practice. Methods A recta-analysis was performed using trials identified through the Cochrane Library, Embase, PubMed, Web of Science, CBM, CNKI, as well as other auxiliary retrieval, and collected the RCTs comparing postoperative ehemoradiation with surgery alone in locally advanced esophageal cancer until 20 October 2016. The quality of study was evaluated with Cochrane quality standards, and statistical analysis was performed using Review Manager software, version 5.3. Results 5 RCTs were analyzed in the study. Meta-analysis showed that the differences of 1-year survival rate （OR=1.63, 95%CI： 1.17-2.28, P=0.004）, 3-year survival rate （OR=2.18, 95%CI： 1.60-2.97, P 〈 0.00001）, 5-year survival rate （OR=2.08, 95%C1： 1.48-2.92, P 〈 0.0001）, 10-year survival rate （OR=2.20, 95%CI： 1.21-4.01, P=0.010）, local recurrence rate （OR=0.28, 95%CI： 0.18-0.43, P 〈 0.00001） were statistically significant between the two groups, which in the postoperative chemoradiation group were superior to the surgery alone group. The differences of surgical complication rate （OR=1.10, 95%CI： 0.61-1.97, P=0.75）, distant metastasis rate （0R=0.75, 95%CI： 0.49- 1.14, P=0.18） were not statistically significant between the two groups. Conclusion The postoperative chemoradiation can provide benefits in effectiveness and safety for locally advanced esophageal cancer than surgery alone, but it is still required for verification through multi-center and large sample randomized clinical trials.

关 键 词：食管癌 术后放化疗 单纯手术 随机对照实验 META分析 

分 类 号：R734[医药卫生—肿瘤]