Department of Biostatistics and Epidemiology, Institut Gustave Roussy, Villejuif, France.
J Clin Epidemiol. 2011 Sep;64(9):985-92. doi: 10.1016/j.jclinepi.2010.10.016. Epub 2011 Feb 18.
Different treatments have been investigated in head and neck cancers (HNCs) but not all of them have been appraised using pairwise comparison. This has resulted in failure to directly identify the best treatment with standard methods. Mixed treatment comparison (MTC) meta-analysis allows one to perform simultaneous inference regarding all treatments and select the best among them.
We applied MTC models to the Meta-Analyses of Chemotherapy and Radiotherapy in HNC, which pooled individual patient data concerning more than 24,000 patients involved in 102 trials. Fixed- and random-effects models, models with or without consistency factors, possibly adapted to multiarm trials are discussed.
Altered fractionated concomitant chemoradiotherapy (AF-CRT) leads to the highest probability of survival in nonmetastatic HNC. The probability that AF-CRT is the best treatment is 94% with random-effects models. There was no relevant inconsistency. When only the most recent trials were selected, AF-CRT and concomitant chemoradiotherapy (CRT) were the two best treatments. AF-CRT remains better than CRT but with a lower posterior probability.
MTC is a powerful method for investigating networks of randomized trials. Homogeneity, similarity of trial designs, populations, and the consistency of the network should be thoroughly checked.
在头颈部癌症（HNC）中已经研究了不同的治疗方法，但并非所有方法都使用配对比较进行评估。这导致无法使用标准方法直接确定最佳治疗方法。混合治疗比较（MTC）荟萃分析允许对所有治疗方法进行同时推断，并从中选择最佳方法。
我们将 MTC 模型应用于头颈部癌症的化疗和放疗荟萃分析，该分析汇总了涉及 102 项试验的超过 24000 名患者的个体患者数据。讨论了固定效应和随机效应模型、具有或不具有一致性因素的模型，以及可能适用于多臂试验的模型。
改变分割同期放化疗（AF-CRT）可提高非转移性 HNC 的生存率。随机效应模型中，AF-CRT 是最佳治疗方法的概率为 94%。没有明显的不一致性。当仅选择最新的试验时，AF-CRT 和同期放化疗（CRT）是两种最佳治疗方法。AF-CRT 仍然优于 CRT，但后验概率较低。
MTC 是研究随机试验网络的有力方法。应彻底检查同质性、试验设计、人群和网络的一致性。
