Fanning J, Bennett T Z, Hilgers R D
Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield.
Obstet Gynecol. 1992 Dec;80(6):954-60.
To compare the survival with cisplatin, doxorubicin (Adriamycin), and cyclophosphamide versus that of cisplatin and cyclophosphamide in women with advanced epithelial ovarian cancer, to evaluate the effect of dose intensity, and to evaluate meta-analysis methodology.
Meta-analysis was done on 30 studies of 2060 women with stages III and IV epithelial ovarian cancer. All had 3-year survival data, adequate follow-up, no other chemotherapy, no radiation therapy, and had information for various prognostic variables (age, stage, grade, and residual disease). We used four different methods of meta-analysis: pooled published data and modified effect-size analyses of the entire group (30 studies), and pooled published data and effect-size analyses of the subset of five prospective randomized studies.
Three-year survival for the entire group was 43% for cisplatin, doxorubicin, and cyclophosphamide versus 36% for cisplatin and cyclophosphamide; for the five prospective randomized studies, the rates were 46 and 35%, respectively. The survival advantage of cisplatin, doxorubicin, and cyclophosphamide was statistically significant when analyzed by the pooled published data and modified effect-size meta-analysis of the entire group and the pooled published data meta-analysis of the five prospective randomized studies. The effect-size meta-analysis of the five prospective studies did not reach statistical significance. Total dose intensity and doxorubicin dose intensity were not significantly associated with survival advantage in cisplatin, doxorubicin, and cyclophosphamide use.
There seems to be a survival advantage to treatment with cisplatin, doxorubicin, and cyclophosphamide versus treatment with cisplatin and cyclophosphamide. We believe this to be due to the properties of multiagent chemotherapy (the addition of doxorubicin) rather than to increased dose intensity. In addition, we believe that physicians need to familiarize themselves with meta-analysis methodology.
比较顺铂、阿霉素（多柔比星）和环磷酰胺联合化疗与顺铂和环磷酰胺联合化疗在晚期上皮性卵巢癌女性患者中的生存率，评估剂量强度的影响，并评估荟萃分析方法。
对2060例Ⅲ期和Ⅳ期上皮性卵巢癌女性患者的30项研究进行荟萃分析。所有患者均有3年生存数据、足够的随访时间、未接受其他化疗、未接受放疗，且有各种预后变量（年龄、分期、分级和残留病灶）的信息。我们使用了四种不同的荟萃分析方法：汇总已发表数据并对整个组（30项研究）进行改良效应量分析，以及汇总已发表数据并对五项前瞻性随机研究的子集进行效应量分析。
整个组中，顺铂、阿霉素和环磷酰胺联合化疗的3年生存率为43%，顺铂和环磷酰胺联合化疗的为36%；五项前瞻性随机研究中，相应的生存率分别为46%和35%。通过汇总已发表数据并对整个组进行改良效应量荟萃分析以及对五项前瞻性随机研究进行汇总已发表数据荟萃分析，顺铂、阿霉素和环磷酰胺联合化疗的生存优势具有统计学意义。五项前瞻性研究的效应量荟萃分析未达到统计学意义。总剂量强度和阿霉素剂量强度与顺铂、阿霉素和环磷酰胺联合化疗的生存优势无显著相关性。
顺铂、阿霉素和环磷酰胺联合化疗似乎比顺铂和环磷酰胺联合化疗具有生存优势。我们认为这是由于多药化疗（添加阿霉素）的特性，而非剂量强度增加。此外，我们认为医生需要熟悉荟萃分析方法。
