Qin Ai-Qiu, Liang Zhong-Guo, Ye Jia-Xiang, Li Jing, Wang Jian-Li, Chen Chang-Xian, Song Hong-Lin
Department of Gynecology Oncology, the Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China E-mail :
Asian Pac J Cancer Prev. 2016;17(8):3945-51.
Whether concurrent chemotherapy treatment is superior to radiotherapy alone as an adjuvant regimen for postoperative cervical carcinoma with risk factors remains controversial.
A literature search strategy was used to examine Pubmed, Embase, the Cochrane Library, the China National Knowledge Internet Web, the Chinese Biomedical Database and the Wanfang Database. Article reference lists and scientific meeting abstracts were also screened. Controlled trials comparing concurrent chemoradiotherapy versus radiotherapy alone in postoperative cervical cancer were included. The methodological quality of non-randomized controlled trials was evaluated using the Newcastle-Ottawa Scale. Randomized controlled studies were evaluated with the Cochrane handbook. A meta-analysis was performed with RevMan 5.3.
A total of 1,073 patients from 11 clinical trials were analysed, with 582 patients in the concurrent chemoradiotherapy group and 491 patients in the radiotherapy group. Hazard ratios (HR) of 0.47 (95% CI 0.31-0.72) and 0.50 (95% CI 0.35-0.72) were observed for overall survival and progression-free survival, indicating a benefit from the additional use of concurrent chemotherapy. Subgroup analyses demonstrated that cervical cancer with high risk factors significantly benefitted from concurrent chemotherapy when examining overall survival (HR 0.44, 95% CI 0.28-0.67) and progression-free survival (HR 0.48, 95% CI 0.33-0.70), but patients with intermediate risk factors showed no benefit from concurrent chemotherapy in overall survival (HR 1.72, 95% CI 0.28-10.41) and progression-free survival (HR 1.09, 95% CI 0.19-6.14). No significant differences were observed for grade 3-4 anaemia (risk ratio (RR) 3.87, 95% CI 0.69-21.84), grade 3-4 thrombocytopenia (RR 3.04, 95% CI 0.88- 10.58), grade 3-4 vomiting or nausea (RR 1.71, 95% CI 0.27-10.96), or grade 3-4 diarrhoea (RR 1.40, 95% CI 0.69-2.83). Significant differences were observed for grade 3-4 neutropenia in favour of the radiotherapy group (RR 7.23, 95% CI 3.94-13.26).
Concurrent chemoradiotherapy improves survival in postoperative cervical cancer cases with high risk factors but not in those with intermediate risk factors.
对于有风险因素的术后宫颈癌患者，同步化疗作为辅助治疗方案是否优于单纯放疗仍存在争议。
采用文献检索策略，检索了PubMed、Embase、Cochrane图书馆、中国知网、中国生物医学数据库和万方数据库。还筛选了文章参考文献列表和科学会议摘要。纳入了比较术后宫颈癌同步放化疗与单纯放疗的对照试验。使用纽卡斯尔-渥太华量表评估非随机对照试验的方法学质量。随机对照研究采用Cochrane手册进行评估。使用RevMan 5.3进行荟萃分析。
共分析了来自11项临床试验的1073例患者，同步放化疗组582例，放疗组491例。总生存和无进展生存的风险比（HR）分别为0.47（95%CI 0.31-0.72）和0.50（95%CI 0.35-0.72），表明同步化疗带来了益处。亚组分析表明，在总生存（HR 0.44，95%CI 0.28-0.67）和无进展生存（HR 0.48，95%CI 0.33-0.70）方面，高风险因素的宫颈癌患者从同步化疗中显著获益，但中风险因素的患者在总生存（HR 1.72，95%CI 0.28-10.41）和无进展生存（HR 1.09，95%CI 0.19-6.14）方面未从同步化疗中获益。3-4级贫血（风险比（RR）3.87，95%CI 0.69-21.84）、3-4级血小板减少（RR 3.04，95%CI 0.88-10.58）、3-4级呕吐或恶心（RR 1.71，95%CI 0.27-10.96）或3-4级腹泻（RR 1.40，95%CI 0.69-2.83）方面未观察到显著差异。在3-4级中性粒细胞减少方面观察到显著差异，放疗组更有优势（RR 7.23，95%CI 3.94-13.26）。
同步放化疗可提高高风险因素的术后宫颈癌患者的生存率，但对中风险因素的患者无效。
