Fu Zhan-Zhao, Li Kun, Peng Yong, Zheng Yue, Cao Li-Yan, Zhang Yun-Jie, Sun Yong-Mei
aDepartment of Radiotherapy, the First Hospital of Qinhuangdao bYanshan University cDepartment of Biomedical Engineering, Yanshan University dThe First Hospital of Qinhuangdao eDepartment of Gynaecology, the First Hospital of Qinhuangdao, Qinhuangdao, P.R. China. .
Medicine (Baltimore). 2017 Jan;96(2):e5853. doi: 10.1097/MD.0000000000005853.
The aim of this study was to compare the efficacy and toxicity of different concurrent chemoradiotherapy (CCRT) regimens in the treatment of advanced cervical cancer (CC) by adopting a network meta-analysis.
We searched PubMed and Cochrane Library from the inception of these databases to September 2016, and all cohort studies (CSs) related to different CCRT regimens in the treatment of CC were included. A network analysis was adopted to compare the combination of direct and indirect evidence, to analyze the odds ratio (OR), and to draw a surface under the cumulative ranking curve of the efficacy and toxicity of different CCRT regimens for CC. Cluster analyses were used to group each category based on similar treatment regimens.
Nineteen CSs were enrolled in this network meta-analysis, including 12 CCRT regimens (radiotherapy [RT], CCRT [cisplatin], CCRT [vinorelbine], CCRT [paclitaxel], CCRT [hydroxyurea], CCRT [cisplatin + FU], CCRT [cisplatin + gemcitabine], CCRT [cisplatin + docetaxel], CCRT [cisplatin + paclitaxel], CCRT [cisplatin + amifostine], CCRT [cisplatin + FU + hydroxyurea], and CCRT [cisplatin + vincristine + bleomycin]). The results of the network meta-analysis showed that regarding efficacy, the overall response rate of CCRT (cisplatin + docetaxel) was higher than RT, and the 5-year overall survival (OS) rate of CCRT (cisplatin + FU + hydroxyurea) was relatively higher than CCRT (hydroxyurea). As for toxicity, CCRT (cisplatin) had a lower incidence of leukopenia than CCRT (hydroxyurea), CCRT (cisplatin + FU) and CCRT (cisplatin + paclitaxel), and the incidences of diarrhea and vomiting in CCRT (cisplatin) were lower than those in CCRT (cisplatin + gemcitabine). Additionally, the cluster analysis showed that CCRT (cisplatin) had relatively lower incidences of both hematotoxicity and gastrointestinal toxicity, and CCRT (paclitaxel) had lower gastrointestinal toxicity than other regimens.
Our study demonstrated that CCRT (cisplatin + docetaxel) might be the best choice of CCRT regimens in the treatment of CC, and the 5-year OS rate of CCRT (cisplatin + FU + hydroxyurea) might be the highest among these different regimens. CCRT (cisplatin) might have the lowest toxicity among all the CCRT regimens.
本研究旨在通过网络荟萃分析比较不同同步放化疗（CCRT）方案治疗晚期宫颈癌（CC）的疗效和毒性。
我们检索了PubMed和Cochrane图书馆自建库至2016年9月的文献，纳入了所有与不同CCRT方案治疗CC相关的队列研究（CSs）。采用网络分析比较直接和间接证据的组合，分析比值比（OR），并绘制不同CCRT方案治疗CC的疗效和毒性累积排序曲线下面积。聚类分析用于根据相似的治疗方案对每个类别进行分组。
19项CSs纳入了该网络荟萃分析，包括12种CCRT方案（放疗[RT]、CCRT[顺铂]、CCRT[长春瑞滨]、CCRT[紫杉醇]、CCRT[羟基脲]、CCRT[顺铂+氟尿嘧啶]、CCRT[顺铂+吉西他滨]、CCRT[顺铂+多西他赛]、CCRT[顺铂+紫杉醇]、CCRT[顺铂+氨磷汀]） 、CCRT[顺铂+氟尿嘧啶+羟基脲]和CCRT[顺铂+长春新碱+博来霉素]）。网络荟萃分析结果显示，在疗效方面，CCRT（顺铂+多西他赛）的总缓解率高于RT，CCRT（顺铂+氟尿嘧啶+羟基脲）的5年总生存率（OS）相对高于CCRT（羟基脲）。在毒性方面，CCRT（顺铂）的白细胞减少发生率低于CCRT（羟基脲）、CCRT（顺铂+氟尿嘧啶）和CCRT（顺铂+紫杉醇），CCRT（顺铂）的腹泻和呕吐发生率低于CCRT（顺铂+吉西他滨）。此外，聚类分析表明，CCRT（顺铂）的血液毒性和胃肠道毒性发生率相对较低，CCRT（紫杉醇）的胃肠道毒性低于其他方案。
我们的研究表明，CCRT（顺铂+多西他赛）可能是CC治疗中CCRT方案的最佳选择，CCRT（顺铂+氟尿嘧啶+羟基脲）的5年OS率可能是这些不同方案中最高的。CCRT（顺铂）可能是所有CCRT方案中毒性最低的。
