宫颈小细胞癌新辅助化疗临床价值的Meta分析  

Neoadjuvant chemotherapy for cervical small cell Carcinoma: A Meta-analysis

作　　者：王光艳 贾雪梅[2] WANG Guangyan;JIA Xuemei(Department of Gynaecology,Hospital of Nanjing University Nanjing 210004;Department of Gynaecology and Obstetrics,Women's Hospital of Nanjing Medical University/Nanjing Maternity and Child Health Care Hospital,Nanjing 210004,China.)

机构地区：[1]南京大学医院妇科,江苏南京210004 [2]南京医科大学附属妇产医院/南京市妇幼保健院妇产科,江苏南京210004

出　　处：《中国肿瘤外科杂志》2021年第4期410-415,共6页Chinese Journal of Surgical Oncology

基　　金：江苏省“十三五”科教强卫工程医学重点人才资助项目(ZDRCB2016014)。

摘　　要：目的探讨术前新辅助化疗(NACT)对宫颈小细胞癌患者生存预后的影响。方法在Pubmed、Web of Science、EMBASE、循证医学图书馆(Cochrane library)、万方数据库、中国期刊全文数据库(CNKI)中检索宫颈小细胞癌新辅助化疗有关的随机对照试验及队列研究。对研究中患者一般情况、生存结果、风险比(HR)及其95%的置信区间进行了提取,并运用R语言对数据进行Meta分析。主要研究终点设定为总生存期(OS)。结果共有8项队列研究、总计270例宫颈小细胞癌患者纳入最终分析。分析的结果显示对于宫颈小细胞癌患者,相比单纯手术或手术+术后辅助治疗,术前增加新辅助化疗并不能提高患者OS (HR 1.84, 95%CI:1.24~2.74,P<0.05),早期患者亚组亦是如此。本研究异质性较小(Q检验:I^(2)=0,P=0.75)。结论针对宫颈小细胞癌患者进行新辅助化疗Meta分析,在手术前增加NACT未能改善患者总生存,特别在早期患者中,存在不利于生存的趋势。本研究为开展宫颈小细胞癌临床研究和综合治疗模式的优化提供了依据,早期患者应慎用新辅助化疗。Objective To investigate the effect of preoperative neoadjuvant chemotherapy(NACT) on survival and prognosis of patients with small cell carcinoma of the cervix(SCCC). Methods We conducted a meta-analysis to estimate the effect of preoperative NACT for SCCC patients. The randomized controlled trials and cohort studies on NACT for SCCC were searched from PubMed, EMBASE, Cochrane, WFSD, CNKI and Web of Science. The general characteristics, survival outcomes of the patients and the hazard ratio(HR) with 95% confidence interval(CI) were collected and analyzed using R studio. The overall survival(OS) was the primary endpoint of interest. Results Eight cohort studies with 270 SCCC patients were included in the meta-analysis in total. The results showed that SCCC patients who were treated with NACT had a negative effect on OS compared with the patients with surgery alone or surgery plus adjuvant therapy(HR 1.84, 95% CI :1.24~2.74, P<0.05). Similar results were achieved when it came to the subgroup analysis of subjects containing only SCCC patients in early stage. The results of heterogeneity analysis showed a low heterogeneity with I^(2) =0 and P value of Q test =0.75. Conclusions Neoadjuvant chemotherapy before surgery may not improve the OS of SCCC patients, with especially an adverse trend of survival in early stage SCCC patients. NACT should be used with caution in early stage patients.

关 键 词：宫颈小细胞癌 早期 新辅助化疗 META分析 

分 类 号：R737.33[医药卫生—肿瘤]