食管癌术前放化疗：一项系统评价与荟萃分析
Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis.
作者信息
Fiorica F, Di Bona D, Schepis F, Licata A, Shahied L, Venturi A, Falchi A M, Craxì A, Cammà C
机构信息
Cattedra di Radioterapia Oncologica, University of Modena e Reggio Emilia, Italy.
出版信息
Gut. 2004 Jul;53(7):925-30. doi: 10.1136/gut.2003.025080.
BACKGROUND
The benefit of neoadjuvant chemoradiotherapy in oesophageal cancer has been extensively studied but data on survival are still equivocal.
OBJECTIVE
To assess the effectiveness of chemoradiotherapy followed by surgery in the reduction of mortality in patients with resectable oesophageal cancer.
METHODS
Computerised bibliographic searches of MEDLINE and CANCERLIT (1970-2002) were supplemented with hand searches of reference lists.
STUDY SELECTION
Studies were included if they were randomised controlled trials (RCTs) comparing preoperative chemoradiotherapy plus surgery with surgery alone, and if they included patients with resectable histologically proven oesophageal cancer without metastatic disease. Six eligible RCTs were identified and included in the meta-analysis.
DATA EXTRACTION
Data on study populations, interventions, and outcomes were extracted from each RCT according to the intention to treat method by three independent observers and combined using the DerSimonian and Laird method.
RESULTS
Chemoradiotherapy plus surgery compared with surgery alone significantly reduced the three year mortality rate (odds ratio (OR) 0.53 (95% confidence interval (CI) 0.31-0.93); p = 0.03) (number needed to treat = 10). Pathological examination showed that preoperative chemoradiotherapy downstaged the tumour (that is, less advanced stage at pathological examination at the time of surgery) compared with surgery alone (OR 0.43 (95% CI 0.26-0.72); p = 0.001). The risk for postoperative mortality was higher in the chemoradiotherapy plus surgery group (OR 2.10 (95% CI 1.18-3.73); p = 0.01).
CONCLUSIONS
In patients with resectable oesophageal cancer, chemoradiotherapy plus surgery significantly reduces three year mortality compared with surgery alone. However, postoperative mortality was significantly increased by neoadjuvant chemoradiotherapy. Further large scale multicentre RCTs may prove useful to substantiate the benefit on overall survival.
背景
新辅助放化疗在食管癌治疗中的益处已得到广泛研究，但生存数据仍不明确。
目的
评估放化疗后手术在降低可切除食管癌患者死亡率方面的有效性。
方法
通过计算机检索MEDLINE和CANCERLIT（1970 - 2002年），并补充手工检索参考文献列表。
研究选择
纳入的研究需为随机对照试验（RCT），比较术前放化疗加手术与单纯手术，且纳入组织学确诊的无转移疾病的可切除食管癌患者。确定了6项符合条件的RCT并纳入荟萃分析。
数据提取
根据意向性分析方法，由3名独立观察者从每项RCT中提取关于研究人群、干预措施和结局的数据，并使用DerSimonian和Laird方法进行合并。
结果
与单纯手术相比，放化疗加手术显著降低了三年死亡率（比值比（OR）0.53（95%置信区间（CI）0.31 - 0.93）；p = 0.03）（需治疗人数 = 10）。病理检查显示，与单纯手术相比，术前放化疗使肿瘤降期（即手术时病理检查分期较晚）（OR 0.43（95% CI 0.26 - 0.72）；p = 0.001）。放化疗加手术组术后死亡风险更高（OR 2.10（95% CI 1.18 - 3.73）；p = 0.01）。
结论
对于可切除食管癌患者，放化疗加手术与单纯手术相比显著降低了三年死亡率。然而，新辅助放化疗显著增加了术后死亡率。进一步的大规模多中心RCT可能有助于证实对总生存的益处。
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