Huang Ting-Chieh, Chen Chi-Jen, Ding Yi-Fang, Kang Yi-No
Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Department of Otolaryngology Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.
Front Oncol. 2022 Sep 13;12:965719. doi: 10.3389/fonc.2022.965719. eCollection 2022.
Induction chemotherapy followed by concurrent chemoradiotherapy (IC-CCRT) may be beneficial for nasopharyngeal carcinoma. However, the evidence on medium- and long-term effects of IC-CCRT is limited, and new randomized controlled trials (RCTs) have been published after 2018. Therefore, this systematic review and meta-analysis compared survival rates between patients with nasopharyngeal carcinoma receiving IC-CCRT or concurrent chemoradiotherapy (CCRT).
Four databases were searched for RCTs on this topic. Two authors independently selected studies, assessed evidence, and extracted data on progression-free survival, overall survival, metastasis-free survival, and local recurrence-free survival. Available data were pooled in a random-effects model and mainly presented in hazard ratio (HR). Heterogeneity and small study effects were also evaluated.
Eleven RCTs (n = 3345) were deemed eligible. Pooled results revealed that patients receiving IC-CCRT had significantly improved progression-free survival (HR = 0.66, < 0.05), overall survival (HR = 0.64, < 0.05), metastasis-free survival (HR = 0.58, < 0.05), and local recurrence-free survival (HR = 0.69, < 0.05) at 3 years, but no significant difference in 5-year overall survival was noted between IC-CCRT and CCRT (HR = 0.84, > 0.05). Most findings had low heterogeneity.
IC-CCRT may benefit patients with nasopharyngeal carcinoma in the medium term, although no significant difference was observed in 5-year survival compared with CCRT. All outcomes had decreased survival rate from the 3-years to 5-year follow-up. Differences in patient ethnicities and regimens of IC-CCRT may be sources of heterogeneity.
诱导化疗后序贯同步放化疗（IC-CCRT）可能对鼻咽癌有益。然而，关于IC-CCRT中长期疗效的证据有限，且2018年后有新的随机对照试验（RCT）发表。因此，本系统评价和荟萃分析比较了接受IC-CCRT或同步放化疗（CCRT）的鼻咽癌患者的生存率。
检索四个数据库中关于该主题的RCT。两位作者独立选择研究、评估证据，并提取无进展生存期、总生存期、无转移生存期和无局部复发生存期的数据。可用数据采用随机效应模型进行汇总，主要以风险比（HR）表示。还评估了异质性和小研究效应。
11项RCT（n = 3345）被认为符合条件。汇总结果显示，接受IC-CCRT的患者在3年时无进展生存期（HR = 0.66，<0.05）、总生存期（HR = 0.64，<0.05）、无转移生存期（HR = 0.58，<0.05）和无局部复发生存期（HR = 0.69，<0.05）均有显著改善，但IC-CCRT和CCRT在5年总生存期方面无显著差异（HR = 0.84，>0.05）。大多数研究结果异质性较低。
IC-CCRT可能在中期使鼻咽癌患者获益，尽管与CCRT相比5年生存率无显著差异。所有结局从3年随访到5年随访生存率均有所下降。患者种族和IC-CCRT方案的差异可能是异质性的来源。
