Liu Yun, Yang Lu, Zhang Shuang, Lin Bing
Department of Internal Medicine-Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou, China.
Department of Radiotherapy, The First Affiliated Hospital of Hainan Medical University, Haikou, China.
Transl Cancer Res. 2022 May;11(5):1207-1218. doi: 10.21037/tcr-22-604.
Although nasopharyngeal carcinoma (NPC) is very sensitive to radiotherapy, patients with advanced NPC still need concurrent chemoradiotherapy (CCRT). The induction chemotherapy (IC) before CCRT can possiblly reduce the distant metastasis rate and improve the survival rate, but the results of studies varied. In this meta-analysis, we included controlled clinical studies to systematically evaluate the gain effect of it.
The PubMed, Web of Science, Wiley online library, Elsevier, CNKI, and Clinicaltrials.gov databases were electronically searched using keywords "neoadjuvant chemotherapy/induction chemotherapy" and "concurrent chemoradiotherapy" and "nasopharyngeal carcinoma" for articles from the date of establishment of the database to January, 2022. The inclusion criteria was established according to the PICOS principles. The complete response rate, progression-free survival (PFS), distant metastasis-free survival (DMFS), and overall survival (OS) were used as the main efficacy indicators for analysis.
Thirteen articles were included with a total of 7,197 patients, including 3,764 patients who took IC + CCRT and 3,433 patients who received CCRT alone. Two randomized controlled trials (RCTs) included had low risk of bias and 11 cohort studies had some concerns of risk. Meta-analysis showed that IC did not significantly increase the complete response rate [risk ratio (RR) =1.03, 95% confidence interval (CI): 0.96-1.11, P=0.336], the pooled hazard ratio (HR) of IC as a prognostic factor predicting PFS was (HR =0.87, 95% CI: 0.78-0.96, P=0.214), and DMFS (HR =0.76, 95% CI: 0.57-0.96, P=0.004), and OS (HR =0.82, 95% CI: 0.73-0.92, P=0.036). IC increased the adverse effects experienced by patients (RR =1.22, 95% CI: 1.00-1.47, P=0.045).
The use of IC before CCRT provided a good effect for NPC patients with tumor, node & metastasis (TNM) stages III and IV, but there was no significant gain for patients with stage II. In addition, the application of IC will increase the toxicity in the oral cavity, digestive tract, and bone marrow, and should be well considered about the toleration of patients. Due to the limitations of this study, more literatures with better quality are needed for further explore into this topic.
尽管鼻咽癌（NPC）对放疗非常敏感，但晚期鼻咽癌患者仍需要同步放化疗（CCRT）。CCRT前的诱导化疗（IC）可能会降低远处转移率并提高生存率，但研究结果各不相同。在这项荟萃分析中，我们纳入了对照临床研究以系统评估其获益效果。
使用关键词“新辅助化疗/诱导化疗”、“同步放化疗”和“鼻咽癌”，对PubMed、Web of Science、Wiley在线图书馆、爱思唯尔、中国知网和Clinicaltrials.gov数据库进行电子检索，检索时间从数据库建立之日至2022年1月。根据PICOS原则制定纳入标准。将完全缓解率、无进展生存期（PFS）、无远处转移生存期（DMFS）和总生存期（OS）用作主要疗效指标进行分析。
纳入13篇文章，共7197例患者，其中3764例接受IC + CCRT，3433例仅接受CCRT。纳入的两项随机对照试验（RCT）偏倚风险低，11项队列研究存在一些风险问题。荟萃分析表明，IC并未显著提高完全缓解率[风险比（RR）=1.03，95%置信区间（CI）：0.96 - 1.11，P = 0.336]，IC作为预测PFS的预后因素的合并风险比（HR）为（HR = 0.87，95%CI：0.78 - 0.96，P = 0.214），DMFS（HR = 0.76，95%CI：0.57 - 0.96，P = 0.004），以及OS（HR = 0.82，95%CI：0.73 - 0.92，P = 0.036）。IC增加了患者经历的不良反应（RR = 1.22，95%CI：1.00 - 1.47，P = 0.045）。
CCRT前使用IC对肿瘤、淋巴结及远处转移（TNM）分期为III期和IV期的鼻咽癌患者有较好疗效，但对II期患者无显著获益。此外，IC的应用会增加口腔、消化道和骨髓的毒性，应充分考虑患者的耐受性。由于本研究的局限性，需要更多高质量文献进一步探讨该主题。
