II期鼻咽癌的联合放化疗与单纯放疗对比:已发表文献的荟萃分析
Combined chemoradiation vs radiation therapy alone in stage-II nasopharyngeal carcinoma: A meta-analysis of the published literature.
作者信息
Wang Sufang, Li Shan, Shen Liangfang
机构信息
Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China; Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China.
Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China.
出版信息
Curr Probl Cancer. 2018 May-Jun;42(3):302-318. doi: 10.1016/j.currproblcancer.2018.03.004. Epub 2018 Apr 3.
The aim of this meta-analysis was to evaluate the efficacy and toxicity of adding chemotherapy to radiotherapy (RT) in the treatment of stage-II nasopharyngeal carcinoma (NPC). We searched Pubmed, Cochrane Library, Embase, China National Knowledge Internet, China Biology Medicine, VIP, and Wanfang database for studies of the RT with or without chemotherapy in patients with stage-II NPC that were published in any language. Analyses were carried out using RevMan 5.3 software. The relative risk was used to evaluate the data, the I test was used to compare heterogeneity, sensitivity analysis was used to evaluate the stability and reliability of the results. There were 16 studies with 3038 patients that were included in this analysis. Risk ratios (RR) of 1.04 (95% CI: 1.01-1.06), 1.05 (95% CI: 1.00-1.10), 1.05 (95% CI: 1.02-1.07), and 1.00 (95% CI: 0.97-1.03) were observed for overall survival (OS), progression-free survival (PFS), locoregional failure-free survival (LRFS), and distant metastasis-free survival (DMFS). Subgroup analysis showed that compared with conventional RT alone, chemoradiation (CRT) could significantly improve OS (RR = 1.09, 95% CI: 1.03-1.15), PFS (RR = 1.20, 95% CI: 1.08-1.35), and LRFS (RR = 1.09, 95% CI: 1.04-1.14), but did not significantly improve the rate of DMFS (RR = 1.03, 95% CI: 0.94-1.12). However, compared with intensity modulated radiation therapy alone, CRT did not significantly improve the rate of OS (RR = 1.01, 95% CI: 0.99-1.03), PFS (RR = 0.99, 95% CI: 0.95-1.03), LRFS (RR = 1.02, 95% CI: 0.99-1.05), and DMFS (RR = 0.99, 95% CI: 0.96-1.01). Compared with conventional RT alone, CRT could significantly improve patients' prognoses in terms of OS, PFS, and LRFS for stage-II NPC, but not DMFS, and CRT can provide greater benefits from concurrent chemotherapy than neoadjuvant chemotherapy. With intensity modulated radiation therapy, the stage-II NPC patients did not benefit from the addition of chemotherapy.
本荟萃分析的目的是评估在II期鼻咽癌(NPC)治疗中,放疗(RT)联合化疗的疗效和毒性。我们检索了PubMed、Cochrane图书馆、Embase、中国知网、中国生物医学数据库、维普数据库和万方数据库,查找以任何语言发表的关于II期NPC患者接受或未接受化疗的放疗研究。使用RevMan 5.3软件进行分析。采用相对危险度评估数据,用I检验比较异质性,用敏感性分析评估结果的稳定性和可靠性。本分析纳入了16项研究,共3038例患者。总生存(OS)、无进展生存(PFS)、无局部区域复发生存(LRFS)和无远处转移生存(DMFS)的风险比(RR)分别为1.04(95%CI:1.01 - 1.06)、1.05(95%CI:1.00 - 1.10)、1.05(95%CI:1.02 - 1.07)和1.00(95%CI:0.97 - 1.03)。亚组分析显示,与单纯常规放疗相比,放化疗(CRT)可显著改善OS(RR = 1.09,95%CI:1.03 - 1.15)、PFS(RR = 1.20,95%CI:1.08 - 1.35)和LRFS(RR = 1.09,95%CI:1.04 - 1.14),但未显著提高DMFS率(RR = 1.03,95%CI:0.94 - 1.12)。然而,与单纯调强放疗相比,CRT未显著提高OS率(RR = 1.01,95%CI:0.99 - 1.03)、PFS率(RR = 0.99,95%CI:0.95 - 1.03)、LRFS率(RR = 1.02,95%CI:0.99 - 1.05)和DMFS率(RR = 0.99,95%CI:0.96 - 1.01)。与单纯常规放疗相比,CRT可显著改善II期NPC患者的OS、PFS和LRFS预后,但不能改善DMFS预后,且与新辅助化疗相比,同步化疗的CRT能带来更大益处。对于调强放疗,II期NPC患者未从化疗中获益。