Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Korea.
Br J Cancer. 2013 Jan 15;108(1):39-48. doi: 10.1038/bjc.2012.516. Epub 2012 Nov 22.
Although chemotherapeutic regimens containing a taxane or platinum agent have been widely recommended for unfavourable carcinoma of unknown primary (CUP), no evidence exists for the superiority of any administered regimens. To date, the efficacy has been mostly assessed in the limited setting of phase II trials, and few attempts have been made to synthesise all available data for survival outcomes.
Electronic databases were searched from 1980 to 2011. Survival results were combined for each pre-specified category of regimens using a random-effects model, and meta-regression models were used to adjust for heterogeneity in some known prognostic factors.
A total of 32 studies were included for meta-analysis. Tendency towards better survival outcome by platinums or taxanes was indicated. After adjustment for important prognostic factors, however, the difference between the platinum-based and non-platinum regimens became no longer significant. Survival benefits by the taxane-based regimens remained significant, with a prolonged median survival time of 1.52 months (P=0.03) and a higher 1-year survival rate of 6.25% (P=0.05), but the benefit did not sustain for 2 years.
Although no effective therapies have been established, this meta-analysis helps to fill an important gap of evidence. However, caution should still be taken because of the potential unmeasured confounding.
尽管含有紫杉烷类或铂类药物的化疗方案已被广泛推荐用于治疗预后不良的不明原发癌（CUP），但目前尚无证据表明任何已应用的方案具有优越性。迄今为止，其疗效主要在有限的 II 期临床试验中进行评估，很少有尝试对所有可用数据进行综合分析以获得生存结果。
从 1980 年到 2011 年，检索电子数据库。使用随机效应模型对每个预先指定的方案类别进行生存结果的综合，并使用荟萃回归模型对一些已知的预后因素的异质性进行调整。
共纳入 32 项研究进行荟萃分析。结果表明铂类或紫杉烷类药物有改善生存的趋势。然而，在调整了重要的预后因素后，铂类方案与非铂类方案之间的差异不再显著。基于紫杉烷类的方案仍有生存获益，中位生存时间延长 1.52 个月（P=0.03），1 年生存率提高 6.25%（P=0.05），但 2 年的生存获益并不持续。
尽管尚未确定有效的治疗方法，但这项荟萃分析有助于填补证据的重要空白。然而，由于潜在的未测量混杂因素，仍需谨慎。
