Wang Mengmeng, Tian Huimin, Li Gang, Ge Tingwen, Liu Yudi, Cui Jiuwei, Han Fujun
Cancer Center, The First Hospital of Jilin University, Changchun, China.
Department of Thyroid and Breast Surgery, No.458 Hospital of People's Liberation Army, Guangzhou, China.
Oncotarget. 2016 Jul 26;7(30):48375-48390. doi: 10.18632/oncotarget.10237.
We did a meta-analysis to compare the efficacy and safety of neoadjuvant chemotherapy (NACT) followed by concurrent chemoradiotherapy (CCRT) versus CCRT with or without adjuvant chemotherapy (AC) for patients with locoregionally advanced nasopharyngeal carcinoma based on randomized controlled trials.
We searched PubMed, Embase, Web of Science, ClinicalTrials.gov, Chinese National Knowledge Infrastructure, and meeting proceedings of major relevant conferences to identify published and unpublished randomized controlled trials. Progression-free survival (PFS) was the primary endpoint.
This meta-analysis included 9 randomized clinical trials with 2215 patients. NACT followed by CCRT significantly improved PFS (HR=0.68, 95% CI 0.56 - 0.81, P < 0.001) compared versus CCRT with or without AC, and no heterogeneity was observed (I2 = 0.0%, P = 0.975). NACT was associated with a significant improvement in overall survival (HR = 0.64, 95% CI 0.49 - 0.84, P = 0.001; I2 = 0.0%, P = 0.467) and distant failure-free survival (HR = 0.72, 95% CI 0.53 - 0.97, P = 0.031; I2 = 0.0%, P = 0.744). No significant benefit was shown by NACT for locoregional control. NACT with CCRT increased risks of grade 3 - 4 anemia, thrombocytopenia, leukopenia, and fatigue, compared versus CCRT with or without AC.
Our meta-analysis confirmed that the addition of NACT to CCRT significantly improved PFS and OS versus CCRT with or without AC for locoregionally advanced nasopharyngeal carcinoma. These results may alter the standard of care - CCRT with or without AC, for locoregionally advanced nasopharyngeal carcinoma.
基于随机对照试验，我们进行了一项荟萃分析，以比较新辅助化疗（NACT）序贯同步放化疗（CCRT）与单纯CCRT或联合辅助化疗（AC）用于局部晚期鼻咽癌患者的疗效和安全性。
我们检索了PubMed、Embase、Web of Science、ClinicalTrials.gov、中国知网以及主要相关会议的会议记录，以识别已发表和未发表的随机对照试验。无进展生存期（PFS）是主要终点。
该荟萃分析纳入了9项随机临床试验，共2215例患者。与单纯CCRT或联合AC相比，NACT序贯CCRT显著改善了PFS（HR=0.68，95%CI 0.56 - 0.81，P<0.001），且未观察到异质性（I2 = 0.0%，P = 0.975）。NACT与总生存期的显著改善相关（HR = 0.64，95%CI 0.49 - 0.84，P = 0.001；I2 = 0.0%，P = 0.467）以及远处无失败生存期（HR = 0.72，95%CI 0.53 - 0.97，P = 0.031；I2 = 0.0%，P = 0.744）。NACT在局部区域控制方面未显示出显著益处。与单纯CCRT或联合AC相比，NACT联合CCRT增加了3 - 4级贫血、血小板减少、白细胞减少和疲劳的风险。
我们的荟萃分析证实，对于局部晚期鼻咽癌患者，在CCRT基础上加用NACT与单纯CCRT或联合AC相比，显著改善了PFS和OS。这些结果可能会改变局部晚期鼻咽癌的标准治疗方案——单纯CCRT或联合AC。
