Tierney J F, Stewart L A, Parmar M K
MRC Clinical Trials Unit, Cambridge, U.K.
Eur J Cancer. 1999 Mar;35(3):406-9. doi: 10.1016/s0959-8049(98)00404-3.
The effect of neoadjuvant chemotherapy on survival of patients with locally advanced cervical cancer was investigated by conducting a systematic review and meta-analysis of the published data. Of the 21 randomised trials that we identified, only 15 were published. Furthermore, 2-year survival data could be extracted from only seven trial reports and 3-year survival from only nine trial reports. Meta-analyses of the published data at 2 and 3 years are neither clearly in favour of neoadjuvant chemotherapy nor control (2 years: odds ratio (OR) = 1.09, 95% confidence interval (CI) = 0.83-1.45, P = 0.37; 3 years: OR = 0.96, 95% confidence interval (CI) = 0.73-1.25, P = 0.45). Being restricted to only some of the data from a relatively small fraction of the randomised trials, these analyses potentially suffer from a number of biases and are therefore inconclusive. The only reliable way to judge the value of neoadjuvant chemotherapy in this disease is to perform a meta-analysis of centrally collected, updated, individual data on all patients from all known randomised trials. Such an analysis is currently being carried out by an international collaborative group.
通过对已发表数据进行系统评价和荟萃分析，研究了新辅助化疗对局部晚期宫颈癌患者生存率的影响。在我们确定的21项随机试验中，仅15项已发表。此外，仅能从7份试验报告中提取2年生存率数据，从9份试验报告中提取3年生存率数据。对已发表的2年和3年数据进行的荟萃分析既未明确支持新辅助化疗，也未支持对照组（2年：比值比（OR）=1.09，95%置信区间（CI）=0.83 - 1.45，P = 0.37；3年：OR = 0.96，95%置信区间（CI）=0.73 - 1.25，P = 0.45）。由于这些分析仅局限于来自相对较少部分随机试验的部分数据，可能存在多种偏倚，因此结论不明确。判断新辅助化疗对该病价值的唯一可靠方法是对所有已知随机试验中所有患者的集中收集、更新的个体数据进行荟萃分析。目前一个国际协作组正在进行这样的分析。
