Zheng Jiabin, Feng Xingyu, Hu Weixian, Wang Junjiang, Li Yong
Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China.
Medicine (Baltimore). 2017 Mar;96(13):e6487. doi: 10.1097/MD.0000000000006487.
Preoperative chemoradiotherapy has become the current standard regimen for locally advanced rectal cancer (LARC). However, the additional benefit of oxaliplatin to preoperative chemotherapy was still controversial. On one hand, oxaliplatin may improve the tumor response rate of even prolong the survival time. On the other hand, it can bring a series of adverse effects. Opinions vary from studies to studies. We aim to perform a meta-analysis to evaluate the efficacy, safety, and long-term survival of oxaliplatin in preoperative chemoradiotherapy for LARC.
To identify clinical trials fusing oxaliplatin in preoperative chemoradiotherapy for LARC published until December 2015, we searched PubMed, the Cochrane Library, and the Springer Link databases by combining various key words. We also search for relevant ASCO conferences. Data were extracted from every study to perform a meta-analysis using STATA 12.0 software.
Eleven articles or ASCO abstracts from 8 studies with a total of 5597 patients were included. Adding oxaliplatin to preoperative chemoradiotherapy can significantly improve the ypCR rate [risk ratio (RR) = 1.208, 95% confidence interval (95% CI): 1.070-1.364, P = 0.002, I = 14.5%], and decrease the preoperative metastasis (RR = 0.494, 95% CI: 0.256-0.954, P = 0.036, I = 53.9%) and local recurrence rate (RR = 0.761, 95% CI: 0.616-0.941, P = 0.012, I = 26.1%). What's more, oxaliplatin can prolong the disease-free survival (DFS) [hazard ratio (HR) = 0.867, 95% CI: 0.741-0.992, P = 0.000, I = 16.3%]. However, oxaliplatin can increase the chemoradiotherapy-related toxicities (RR = 1.858, 95% CI 1.427-2.419, P = 0.000, I = 84.7%). There was no significant difference between the groups with and without oxaliplatin in operation rate, R0 resection rate, sphincter preservation rate, permanent stoma rate, postoperative complication, mortality, and overall survival.
Preoperative chemoradiotherapy with oxaliplatin bring both advantage and disadvantage to LARC. Whether to use oxaliplatin should be decided by patient's general condition and tolerance. Although oxaliplatin can prolong the DFS, survival benefit should be proved by further data.
术前放化疗已成为目前局部晚期直肠癌（LARC）的标准治疗方案。然而，奥沙利铂在术前化疗中的额外获益仍存在争议。一方面，奥沙利铂可能提高肿瘤缓解率甚至延长生存时间。另一方面，它会带来一系列不良反应。不同研究的观点各异。我们旨在进行一项荟萃分析，以评估奥沙利铂在LARC术前放化疗中的疗效、安全性和长期生存情况。
为了识别截至2015年12月发表的关于奥沙利铂用于LARC术前放化疗的临床试验，我们通过组合各种关键词搜索了PubMed、Cochrane图书馆和Springer Link数据库。我们还搜索了相关的美国临床肿瘤学会（ASCO）会议。从每项研究中提取数据，使用STATA 12.0软件进行荟萃分析。
纳入了来自8项研究的11篇文章或ASCO摘要，共5597例患者。在术前放化疗中添加奥沙利铂可显著提高ypCR率[风险比（RR）=1.208，95%置信区间（95%CI）：1.070 - 1.364，P = 0.002，I = 14.5%]，并降低术前转移率（RR = 0.494，95%CI：0.256 - 0.954，P = 0.036，I = 53.9%）和局部复发率（RR = 0.761，95%CI：0.616 - 0.941，P = 0.012，I = 26.1%）。此外，奥沙利铂可延长无病生存期（DFS）[风险比（HR）=0.867，95%CI：0.741 - 0.992，P = 0.000，I = 16.3%]。然而，奥沙利铂会增加放化疗相关毒性（RR = 1.858，95%CI 1.427 - 2.419，P = 0.000，I = 84.7%）。在手术率、R0切除率、括约肌保留率、永久性造口率、术后并发症、死亡率和总生存期方面，使用和未使用奥沙利铂的组间无显著差异。
奥沙利铂术前放化疗对LARC既有优势也有劣势。是否使用奥沙利铂应根据患者的一般状况和耐受性来决定。虽然奥沙利铂可延长DFS，但生存获益仍需更多数据证实。
Zotero 插件
