手术综合治疗与放化疗对于ⅡB期子宫颈癌预后的Meta分析  

Meta-analysis of Prognosis of Stage ⅡB Cervical Cancer by Surgical and Chemoradiation Therapy

作　　者：李广 郑浩杰 黄启涛[1] 黄莉声 秦逸飞 王卉 刘国炳[1] LI Guang;ZHENG Haojie;HUANG Qitao(Department of Obstetrics and Gynecology,Nanfang Hospital,Southern Medical University,Guangzhou Guangdong 510515,China;The First Clinical Medical College of Southern Medical University,Guangzhou Guangdong 510515,China)

机构地区：[1]南方医科大学南方医院妇产科,广东广州510515 [2]南方医科大学第一临床医学院临床医学系,广东广州510515

出　　处：《实用妇产科杂志》2019年第11期846-851,共6页Journal of Practical Obstetrics and Gynecology

基　　金：广东省科技计划项目(编号:2016A020215211)

摘　　要：目的:评价手术综合治疗与放化疗对于FIGOⅡB期子宫颈癌的有效性与安全性。方法:计算机检索PubMed、Cochrane library、EMbase、Web of science、Science direct、Google schoolar等数据库,收集从1966年1月至2019年2月间发表的相关文献,由两位研究员独立按照纳入和排除标准筛选文献、提取数据和文献质量评估,使用Cochrane图书馆数据库提供的RevMan 5.3软件进行Meta分析,探讨手术综合治疗与放化疗对于FIGOⅡB期子宫颈癌预后(包括生存率、复发率、并发症)的影响。结果:共纳入9篇文献共2328例患者,手术综合治疗组1101例,放化疗组1227例。手术综合治疗组与放化疗组的3年生存率(91.50%vs 82.88%)、5年生存率(79.46%vs 79.26%)、无进展生存率(78.96%vs 78.13%)、总复发率(23.82%vs 25.37%)、急性Ⅲ~Ⅳ期毒性反应发生率(47.25%vs 48.52%)比较差异均无统计学意义(P>0.05)。手术综合治疗组的盆腔复发率(10.24%)低于放化疗组(12.88%),差异有统计学意义(OR 0.72,95%CI 0.53~0.96,P=0.03)。手术综合治疗组远期Ⅲ~Ⅳ级毒性反应发生率(12.69%)高于放化疗组(8.51%),差异有统计学意义(OR 1.78,95%CI 1.23~2.58,P=0.002)。结论:对于ⅡB期子宫颈癌的治疗,手术治疗或者放化疗都是可以选择的治疗方式,应该综合考虑多方面因素以决定最优的治疗方式,在有条件的医院可以适当推广手术综合治疗。Objective:To evaluate the efficacy and safety ofsurgical treatment and chemoradiation therapy for FIGO stageⅡB cervical cancer.Methods:PubMed,Cochrane library,Embase,Web of science,science direct,Google scholar and other databases were retrieved by computer to collect relevant literature published from January 1966 to February 2019.Two researchers independently screened,extracted data and assessed the quality of literature according to inclusion and exclusion criteria.A Meta-analysis was conducted using RevMan 5.3 software provided by Cochrane Library database to explore the prognosis(including survival rate,recurrence rate,complications)of surgical treatment and chemoradiation therapy for FIGO stageⅡB cervical cancer.Results:9 articles were ultimately included.All of them were written in English and included a total of 2328 patients(1101 patients insurgical group and 1227 patients in chemoradiation group).There were no significant differences in 3-year survival rate(91.50%vs 82.88%),5-year survival rate(79.46%vs 79.26%),progression-free survival rate(78.96%vs 78.13%),total recurrence rate(23.82%vs 25.37%)and acute toxic reaction rate(47.25%vs 48.52%)between the two groups(P>0.05).The pelvic recurrence rate(10.24%)in surgery group was lower than that in chemora-dio therapy group(12.88%),and the difference was statistically significant(OR 0.72,95%CI 0.53-0.96,P=0.03).The long-term incidence of gradeⅢ-Ⅳtoxic reactions(12.69%)in surgical group was higher than that in chemoradiation group(8.51%).The difference was statistically significant(OR 1.78,95%CI 1.23-2.58,P=0.002).Conclusions:For stageⅡB cervical cancer,the recurrence rate and survival rate after surgery are not inferior to that after chemoradiation therapy and the recurrence rate of pelvic cavity is lower than that of chemoradiation therapy,but the long-term toxicity in surgical group is more serious.Surgical treatment can be properly encouraged in hospitals where conditions permit.

关 键 词：子宫颈癌 FIGOⅡB期 手术 放化疗 同步放化疗 META分析 

分 类 号：R713.4[医药卫生—妇产科学]