辅助放疗与单纯手术治疗pT_(2-3)N_(0)M_(0)期食管鳞癌临床价值的meta分析  

Meta-analysis of clinical value of adjuvant radiotherapy versus surgery alone in the treatment of stage pT_(2-3)N_(0)M_(0)esophageal squamous cell carcinoma

作　　者：崔莉 渠琬溪 袁仕旺 王旻寒 王将 覃朝晖 姚元虎 Cui Li;Qu Wanxi;Yuan Shiwang;Wang Minhan;Wang Jiang;Qin Zhaohui;Yao Yuanhu(Department of Radiation Oncology,The Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China;School of Management,Xuzhou Medical University,Xuzhou 221004,China)

机构地区：[1]徐州医科大学附属医院肿瘤放射治疗科,徐州221006 [2]徐州医科大学管理学院,徐州221004

出　　处：《中华放射肿瘤学杂志》2024年第2期116-122,共7页Chinese Journal of Radiation Oncology

基　　金：2021年度江苏省高校哲学社会科学研究重大项(2021SJZDA136)。

摘　　要：目的比较根治性切除术后pT_(2-3)N_(0)M_(0)期的食管鳞癌患者辅助放疗对比单纯手术治疗的疗效与安全性。方法通过计算机全面检索Web of Science、Embase、PubMed、Cochrane Library、中国知网、维普网、中国生物医学文献数据库、万方等相关数据库,检索时限均从建库至2022年12月。根据纳入和排除标准进行文献筛选,采用RevMan 5.4软件进行meta分析。结果最终纳入8项包括2424例患者的临床对照研究资料。meta分析结果显示,术后辅助放疗与单纯手术相比,有较高的3、5年无瘤生存率(OR=2.33,95%CI为1.71~3.17,P<0.001;OR=2.38,95%CI为1.73~3.27,P<0.001)和3、5年总生存率(OR=1.89,95%CI为1.37~2.60,P<0.01;OR=1.94,95%CI为1.50~2.49,P<0.001),同时,术后辅助放疗组的局部复发率(OR=0.33,95%CI为0.21~0.50,P<0.001)及远处转移率(OR=0.62,95%CI为0.39~0.98,P=0.040)均低于单纯手术。术后放疗不良反应发生率报道了放射性食管炎发生率(1.4%~9.5%)、放射性肺炎发生率(2.1%)和吻合口狭窄发生率(5.3%)。结论对pT_(2-3)N_(0)M_(0)期食管鳞癌根治性切除术后患者,辅助放疗较单纯手术可提高3、5年无瘤生存率和3、5年总生存率,同时辅助放疗可降低局部复发率及远处转移率。因此,术后辅助放疗是pT_(2-3)N_(0)M_(0)期食管鳞癌可选的治疗方案。Objective To compare the efficacy and safety of adjuvant radiotherapy versus surgery alone in patients with stage pT_(2-3)N_(0)M_(0)esophageal squamous cell carcinoma after radical resection.Methods The search was conducted through Web of Science,Emabse,PubMed,Cochrane Library,CNKI,Chongqing VIP,China Biomedical Literature Database,and Wanfang database,etc.The search time was ranged from the establishment of the database to December 2022.Searched studies were screened according to the inclusion and exclusion criteria.Review Manager 5.4 software was used for analysis.Results Clinical data of 2424 patients from 8 controlled clinical studies were finally included.Meta-analysis showed that postoperative adjuvant radiotherapy had higher 3-year and 5-year disease-free survival rates(OR=2.33,95%CI=1.71-3.17,P<0.001;OR=2.38,95%CI=1.73-3.27,P<0.001)and 3-year and 5-year overall survival rates(OR=1.89,95%CI=1.37-2.60,P<0.01;OR=1.94,95%CI=1.50-2.49,P<0.001)than surgery alone.Meanwhile,the local recurrence rate(OR=0.33,95%CI=0.21-0.50,P<0.001)and distant metastasis rate(OR=0.62,95%CI=0.39-0.98,P=0.040)of postoperative adjuvant radiotherapy group were lower than those in the surgery alone group.The incidence of radiation esophagitis(1.4%-9.5%),radiation pneumonitis(2.1%)and anastomotic stenosis(5.3%)was reported.Conclusions For patients with stage pT_(2-3)N_(0)M_(0)squamous cell carcinoma after radical resection of esophageal cancer,adjuvant radiotherapy may improve 3-year and 5-year disease-free survival rates and 3-year and 5-year overall survival rates compared with surgery alone.In addition,adjuvant radiotherapy may reduce the local recurrence and distant metastasis rates.Therefore,postoperative adjuvant radiotherapy is an optional treatment for stage pT_(2-3)N_(0)M_(0)esophageal squamous cell carcinoma.

关 键 词：食道鳞癌 放射疗法 辅助 根治性切除术 预后 荟萃分析 

分 类 号：R735.1[医药卫生—肿瘤]