Zhang Ya, He Zewei, Duan Yanping, Wang Cao, Kamar Santoshi, Shi Xiaoqian, Yang Jifei, Yang Jingqing, Zhao Na, Han Lei, Yang Yihao, Yang Zuozhang
Department of Orthopaedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, PR China.
The Kunming Medical University, Kunming, Yunnan 650000, PR China.
J Bone Oncol. 2018 May 22;12:54-60. doi: 10.1016/j.jbo.2018.04.001. eCollection 2018 Sep.
Meta-analysis.
Although some new insights have been offered for clinical and scientific relevance, minor progress has been made in osteosarcoma treatment after a dramatic survival improvement in the late 1980s with the addition of chemotherapy to surgery. Intensified chemotherapy strategies have been suggested to increase the survival rate of patients with osteosarcoma. We performed this study to access whether intensified chemotherapy strategiesincreased survival outcomes of osteosarcoma patients compared with conventional chemotherapy strategies.
MEDLINE/PubMed, EMBASE, BIOSIS Previews, and Cochrane Library were searched from database set up to October2016. Randomized controlled trials (RCTs) and comparative clinical trials (CCTs) on intensified versus conventional chemotherapy strategies for osteosarcoma patients met the inclusion criteria, and the methodological quality standard were retrieved and reviewed. Data on participant characteristics, interventions, follow-up period, and outcomes were extracted from the included studies and analyzed by Review Manager 5.3.
12 studies (8 RCTs and 4CCT) involving 4112 patients were selected. There were no significant differences between intensified and conventional chemotherapy strategies group in 3-year event-free survival (OR, 1.01; 95% CI, [0.74-1.37]; P = 0.97), 5-year event-free survival (OR, 1.00; 95% CI, [0.86-1.17]; P = 0.97), and 5-year overall survival (OR, 1.04; 95% CI, [0.87-1.26]; P = 0.64), and good histologic response to preoperative chemotherapy (OR, 1.12; 95% CI, [0.78-1.60]; P = 0.55). Pooled analysis of local recurrence rate showed that local recurrence rate was significantly decreased in the intensified group compared with that in the conventional group (OR, 0.60; 95% CI, [0.42-0.85]; P = 0.004).
Intensified chemotherapy might not be a preferred treatment for all of the osteosarcoma patients.
荟萃分析。
尽管在临床和科学相关性方面有了一些新见解，但自20世纪80年代末手术联合化疗使骨肉瘤患者生存率显著提高以来，骨肉瘤治疗进展甚微。有人提出强化化疗策略以提高骨肉瘤患者的生存率。我们开展本研究以评估与传统化疗策略相比，强化化疗策略是否能提高骨肉瘤患者的生存结局。
检索截至2016年10月建立的数据库MEDLINE/PubMed、EMBASE、BIOSIS Previews和Cochrane图书馆。纳入符合纳入标准且方法学质量标准的关于骨肉瘤患者强化与传统化疗策略的随机对照试验（RCT）和比较临床试验（CCT），并进行检索和回顾。从纳入研究中提取有关参与者特征、干预措施、随访期和结局的数据，并使用Review Manager 5.3进行分析。
选择了12项研究（8项RCT和4项CCT），涉及4112例患者。强化化疗策略组与传统化疗策略组在3年无事件生存率（OR，1.01；95%CI，[0.74 - 1.37]；P = 0.97）、5年无事件生存率（OR，1.00；95%CI，[0.86 - 1.17]；P = 0.97）、5年总生存率（OR，1.04；95%CI，[0.87 - 1.26]；P = 0.64）以及术前化疗的良好组织学反应（OR，1.12；95%CI，[0.78 - 1.60]；P = 0.55）方面均无显著差异。局部复发率的汇总分析表明，与传统组相比，强化组的局部复发率显著降低（OR，0.60；95%CI，[0.42 - 0.85]；P = 0.004）。
强化化疗可能并非所有骨肉瘤患者的首选治疗方法。
