Liu Bin, Ge Long, Wang Jing, Chen Ya-Qiong, Ma Shi-Xun, Ma Pei-Lan, Zhang Yun-Qiang, Yang Ke-Hu, Cai Hui
Gansu Provincial Hospital, General Surgery Clinical Medical Center, Lanzhou 730000, Gansu Province, China.
Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, Gansu Province, China.
World J Gastrointest Oncol. 2021 Jan 15;13(1):69-86. doi: 10.4251/wjgo.v13.i1.69.
In recent years, intraoperative radiotherapy (IORT) has been increasingly used for the treatment of rectal cancer. However, the efficacy and safety of IORT for the treatment of rectal cancer are still controversial.
To evaluate the value of IORT for patients with rectal cancer.
We searched PubMed, Embase, Cochrane Library, Web of Science databases, and conference abstracts and included randomized controlled trials and observational studies on IORT non-IORT for rectal cancer. Dichotomous variables were evaluated by odds ratio (OR) and 95% confidence interval (CI), hazard ratio (HR) and 95%CI was used as a summary statistic of survival outcomes. Statistical analyses were performed using Stata V.15.0 and Review Manager 5.3 software.
In this study, 3 randomized controlled studies and 12 observational studies were included with a total of 1460 patients, who are mainly residents of Europe, the United States, and Asia. Our results did not show significant differences in 5-year overall survival (HR = 0.80, 95%CI = 0.60-1.06; = 0.126); 5-year disease-free survival (HR = 0.94, 95%CI = 0.73-1.22; = 0.650); abscess (OR = 1.10, 95%CI = 0.67-1.80; = 0.713), fistulae (OR = 0.79, 95%CI = 0.33-1.89; = 0.600); wound complication (OR = 1.21, 95%CI = 0.62-2.36; = 0.575); anastomotic leakage (OR = 1.09, 95%CI = 0.59-2.02; = 0.775); and neurogenic bladder dysfunction (OR = 0.69, 95%CI = 0.31-1.55; = 0.369). However, the meta-analysis of 5-year local control was significantly different (OR = 3.07, 95%CI = 1.66-5.66; = 0.000).
The advantage of IORT is mainly reflected in 5-year local control, but it is not statistically significant for 5-year overall survival, 5-year disease-free survival, and complications.
近年来，术中放疗（IORT）越来越多地用于直肠癌的治疗。然而，IORT治疗直肠癌的疗效和安全性仍存在争议。
评估IORT对直肠癌患者的价值。
我们检索了PubMed、Embase、Cochrane图书馆、Web of Science数据库和会议摘要，纳入了关于IORT与非IORT治疗直肠癌的随机对照试验和观察性研究。二分变量通过比值比（OR）和95%置信区间（CI）进行评估，风险比（HR）和95%CI用作生存结局的汇总统计量。使用Stata V.15.0和Review Manager 5.3软件进行统计分析。
本研究纳入了3项随机对照研究和12项观察性研究，共1460例患者，主要来自欧洲、美国和亚洲。我们的结果显示，5年总生存率（HR = 0.80，95%CI = 0.60 - 1.06；P = 0.126）、5年无病生存率（HR = 0.94，95%CI = 0.73 - 1.22；P = 0.650）、脓肿（OR = 1.10，95%CI = 0.67 - 1.80；P = 0.713）、瘘管（OR = 0.79，95%CI = 0.33 - 1.89；P = 0.600）、伤口并发症（OR = 1.21，95%CI = 0.62 - 2.36；P = 0.575）、吻合口漏（OR = 1.09，95%CI = 0.59 - 2.02；P = 0.775）和神经源性膀胱功能障碍（OR = 0.69，95%CI = 0.31 - 1.55；P = 0.369）方面无显著差异。然而，5年局部控制的荟萃分析有显著差异（OR = 3.07，95%CI = 1.66 - 5.66；P = 0.000）。
IORT的优势主要体现在5年局部控制方面，但对5年总生存率、5年无病生存率和并发症方面无统计学意义。
