Su Yu-xiong, Zheng Jia-wei, Zheng Guang-sen, Liao Gui-qing, Zhang Zhi-yuan
Department of Oral and Maxillofacial Surgery, College of Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Chin Med J (Engl). 2008 Oct 5;121(19):1939-44.
The benefit of neoadjuvant chemotherapy in the management of head and neck squamous cell carcinomas (HNSCC) still remains controversial. The aim of this meta-analysis is to evaluate the role of the neoadjuvant chemotherapy with the cisplatin and fluororacil (PF) regimen in enhancing the overall survival of and decreasing locoregional relapse and distant metastasis in HNSCC patients.
Medline and manual searches were performed to identify all published randomized controlled trials (RCTs) investigating the efficacy of the neoadjuvant chemotherapy with the PF regimen. Outcomes assessed by meta-analysis included locoregional relapse, distant metastasis, and overall survival. The odds ratio was the principle measurement of effect, which was calculated as the treatment group (chemotherapy plus locoregional treatment) versus the control group (locoregional treatment alone) and was presented as a point estimate with 95% confidence intervals (CI).
Eight RCTs were adopted for analysis. The meta-analysis showed that the odds ratio for the locoregional relapse was 0.92 (0.70 - 1.22, 95% CI), which was not statistically significant. The odds ratios for distant metastasis and overall survival were 0.47 (0.33 - 0.68, 95% CI) and 1.28 (1.01 - 1.62, 95% CI) respectively, which were both statistically significant.
Neoadjuvant chemotherapy with the PF regimen in HNSCC patients has no effect on locoregional relapse. However, it shows a small but significant benefit in reducing distant metastasis and improving the overall survival.
新辅助化疗在头颈部鳞状细胞癌（HNSCC）治疗中的益处仍存在争议。本荟萃分析的目的是评估顺铂和氟尿嘧啶（PF）方案新辅助化疗在提高HNSCC患者总生存率、降低局部区域复发和远处转移方面的作用。
通过检索Medline并进行手工检索，以识别所有已发表的研究PF方案新辅助化疗疗效的随机对照试验（RCT）。荟萃分析评估的结果包括局部区域复发、远处转移和总生存率。优势比是主要的效应测量指标，计算为治疗组（化疗加局部区域治疗）与对照组（单纯局部区域治疗）之比，并以点估计值和95%置信区间（CI）表示。
纳入八项RCT进行分析。荟萃分析显示，局部区域复发的优势比为0.92（0.70 - 1.22，95%CI），无统计学意义。远处转移和总生存率的优势比分别为0.47（0.33 - 0.68，95%CI）和1.28（1.01 - 1.62，95%CI），均具有统计学意义。
PF方案新辅助化疗对HNSCC患者的局部区域复发无影响。然而，它在减少远处转移和提高总生存率方面显示出虽小但显著的益处。
