新辅助放化疗结合手术与单纯手术治疗可切除食管癌的系统评价与Meta分析  

Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for esophageal neoplasms: A systematic review and meta-analysis

作　　者：杨振宇[1] 朱泽武 阿来古哈 陈龙奇 YANG Zhenyu ZHU Zewu ALAI Guha CHEN Longqi(West China School of Medicine, Sichuan University, Chengdu, 610041, P.R.China Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, P.R.China)

机构地区：[1]四川大学华西临床医学院,成都610041 [2]四川大学华西医院胸外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2017年第11期867-879,共13页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨术前放化疗(chemoradiotherapy followed by surgery,CRTS)对比单纯手术(surgery alone,SA)治疗可切除食管癌患者的有效性以及安全性。方法检索Pub Med、Ovid、SCI,中国生物医学文献数据库、中国学术期刊全文数据库、维普数据库、万方数据库等,收集2015年8月1日以前有关术前放化疗与单纯手术治疗可切除食管癌的文献,严格按照纳入和排除标准进行筛选后提取数据。数据分析采用Stata12.0软件。结果共纳入26个随机对照试验(RCT),研究对象共3 252例,其中CRTS组1 606例,SA组1 646例。CRTS组3年生存率、5年生存率、R0切除率高于SA组,其RR(95%CI,P值)分别为1.24(1.13~1.36,P<0.000 1)、1.29(1.10~1.50,P=0.001)、1.13(1.05~1.21,P=0.001),同时降低了局部复发率与局部复发并远处转移率,其RR(95%CI,P值)分别为0.67(0.52~0.85,P=0.001)、0.60(0.40~0.90,P=0.013),其差异均有统计学意义(P<0.05),两组1年生存率与远处转移率差异均无统计学意义,其RR(95%CI,P值)分别为1.05(0.99~1.12,P=0.103)、0.84(0.70~1.00,P=0.053)。与SA组比较,CRTS组总并发症、术后30 d死亡率、肺部感染、吻合口瘘、吻合口狭窄、心脏并发症、乳糜胸的发生率并未增加,其RR(95%CI,P值)分别为1.09(0.96~1.24,P=0.166)、1.32(0.96~1.83,P=0.485)、1.45(0.94~2.23,P=0.091)、0.89(0.63~1.25,P=0.485)、0.93(0.64~1.35,P=0.731)、1.24(0.84~1.87,P=0.283)、1.62(0.85~3.07,P=0.142),其差异均无统计学意义。结论与SA相比,CRTS治疗可切除食管癌有效性更高,安全性相当。Objective To evaluate the efficacy and safety of neoadjuvant chemotherapy （a CRTS group） plus surgery versus surgery alone （a SA group） in the treatment of resectable esophageal neoplasms. Methods PubMed, Ovid Technologies, SCI, CBM Database, CNKI Database, VIP Database and Wanfang Database were searched to identify all published or unpublished RCTs those compared neoadjuvant chemotherapy plus surgery with surgery alone for resectable esophageal neoplasms up to August 1, 2015. Meta-analysis was conducted by using Stata12.0 software. Results Twenty-six RCTs included 3 252 patients （1 606 in the CRTS group, 1 646 in the SA group） were selected. There was a significant difference between the CRTS group and the SA group in 3-year survival rate, 5-year survival rate, R0 resection rate, local recurrence rate, local recurrence and distant metastasis rate with relative risk （RR） value and 95%CI at 1.24 （1.13-1.36, P〈0.000 1）, 1.29 （1.10-1.50,P=0.001）, 1.13 （1.05-1.212, P=0.001）, 0.67 （0.52-0.85, P=0.001）, 0.60 （0.40-0.90, P=0.013）. And there was no significant difference between the CRTS group and the SA group in 1-year survival rate and distant metastasis with RR （95%CI） of 1.05 （0.99-1.12, P=0.103） and 0.84 （0.70-1.00, P=0.053）. There was no significant difference in postoperative complications, 30-days mortality, pulmonary infections, anastomotic leakage, anastomotic stricture, cardiac complications, chylothorax between the two groups with RR （95%CI） at 1.09 （0.96-1.24, P=0.166）, 1.32 （0.96-1.83, P=0.485）, 1.45 （0.94-2.23, P=0.091）, 0.89 （0.63-1.25, P=0.485）, 0.93 （0.64-1.35, P=0.731）, 1.24（0.84-1.87, P=0.283）, and 1.62 （0.85-3.07, P=0.142）. Conclusion CRTS significantly benefits to survival rate, R0 rescetion rate, and local recurrence rate compared to SA. Additionally there is no increased postoperative complication for patients with resectable esophageal neoplasms.

关 键 词：术前放化疗 单纯手术 可切除食管癌 META分析 

分 类 号：R735.1[医药卫生—肿瘤]