不可切除食管癌紫杉烷或氟尿嘧啶类联合铂类同步放化疗荟萃分析  

Meta-analysis for unrespectable esophageal cancer treated with taxane or fluoropyrimidine plus platinum concurrent with radiation

作　　者：王涛[1] 李颖[2] 张西志[2] 李军 陈勇[2] WANG Tao;LI Ying;ZHANG Xi-zhi;LI Jun;CHEN Yong(Department of Medical Oncology,Jiangdu People’s Hospital Affiliated to Medical College of Yangzhou University,Yangzhou 225200,P.R.China;Medical College of Yangzhou University and Department of Medical Oncology,Northern Jiangsu People’s Hospital,Yangzhou 225001,P.R.China)

机构地区：[1]扬州大学医学院附属江都人民医院肿瘤科,江苏扬州225200 [2]扬州大学医学院,江苏省苏北人民医院肿瘤科,江苏扬州225001

出　　处：《中华肿瘤防治杂志》2020年第4期316-325,共10页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的紫杉烷联合铂类及氟尿嘧啶类联合铂类均是食管癌的标准治疗方案,但二者之间的优劣尚不明确。本研究旨在应用荟萃分析方法比较紫杉烷联合铂类(taxane plus platinum,TP)与氟尿嘧啶类联合铂类(taxane plus platinum,FP)的同步放化疗治疗不可切除食管癌的临床疗效及安全性。方法检索PubMed、Embase、中国知网和万方数据库,检索时间截止至2018-12-18,收集所有对比TP与FP的同步放化疗治疗不可切除食管癌的队列研究或者随机对照试验。根据纽卡斯尔-渥太华量表(Newcastle-Ottawa scale,NOS)及Cochrane系统评价手册5.0对纳入的研究进行质量评价。采用RevMan5.3软件对相应的指标进行荟萃分析。结果36个研究共纳入3167例患者进行分析,其中随机对照试验20个,队列研究16个。TP的同步放化疗在完全缓解(OR=0.50,95%CI为0.41~0.62,P<0.001)、客观缓解率(OR=0.45,95%CI为0.37~0.55,P<0.001)、疾病控制率(OR=0.45,95%CI为0.32~0.64,P<0.001)、无进展生存期(HR=0.72,95%CI为0.63~0.82,P<0.001)及总生存期(HR=0.78,95%CI为0.69~0.88,P<0.001)方面均优于FP的同步放化疗。TP的同步放化疗在食管鳞癌患者中的疗效同样明显优于FP的同步放化疗。TP的同步放化疗Ⅲ~Ⅳ度白细胞减少的发生率(OR=1.91,95%CI为1.37~2.67,P<0.001)要高于FP的同步放化疗,其Ⅲ~Ⅳ度恶心/呕吐(OR=0.53,95%CI为0.32~0.86,P=0.01)及放射性食管炎(OR=0.52,95%CI为0.39~0.70,P<0.001)的发生率要低于FP的同步放化疗。结论TP同步放化疗治疗不可切除食管癌或者食管鳞癌疗效要优于FP同步放化疗,且增加的不良反应在可耐受范围之内。OBJECTIVE Both taxane plus platinum and fluoropyrimidine plus platinum are standard treatments for esophageal cancer.However,there has not been a consensus whether taxane plus platinum is better than fluoropyrimidine plus platinum.This study aimed to investigate the efficacy and safety of taxane plus platinum(TP)concurrent with radiation over fluoropyrimidine plus platinum(FP)concurrent with radiation in the treatment of unresectable esophageal cancer with the method of meta-analysis.METHODS Medline,Embase,CNKI and WanFang databases were searched for studies comparing efficacy and safety between TP concurrent with radiation and FP concurrent with radiation in unresectable esophageal cancer up to December 18,2018.The quality of each study was evaluated according to the Newcastle-Ottawa Scale(NOS)and the Cochrane Review’s handbook 5.0.RevMan 5.3 statistical analysis software was adopted to analyze corresponding index.RESULTS Twenty randomized controlled trails and 16 cohort studies with a total of 3167 patients were included in the analysis.TP concurrent with radiation showed better complete response(OR=0.50,95%CI:0.41-0.62,P<0.001),objective response rate(OR=0.45,95%CI:0.37-0.55,P<0.001),disease control rate(OR=0.45,95%CI:0.32-0.64,P<0.001),progression free survival(HR=0.72,95%CI:0.63-0.82,P<0.001)and overall survival(HR=0.78,95%CI:0.69-0.88,P<0.001)than FP concurrent with radiation.Furthermore,TP concurrent with radiation also showed better clinical efficacy than FP concurrent with radiation in patients with esophageal squamous cell carcinoma.When compared to FP concurrent with radiation,TP concurrent with radiation can lead to higher incidence rate of grade 3/4 leukopenia(OR=1.91,95%CI:1.37-2.67,P<0.001)but lower incidence rates of grade 3/4 nausea/vomiting(OR=0.53,95%CI:0.32-0.86,P=0.01)and radiation esophagitis(OR=0.52,95%CI:0.39-0.70,P<0.001).CONCLUSION When compared to FP concurrent with radiation,TP concurrent with radiation can produce better clinical efficacy either in unresectable esophageal cancer pat

关 键 词：食管癌 紫杉烷 化疗 同步放化疗 荟萃分析 

分 类 号：R735.1[医药卫生—肿瘤]