Xu Li'ang, Chen Xiaoxi, Wang Lan, Han Jing, Wang Qi, Liu Shutang, Zhang Xiaolin, Han Chun
Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
J Gastrointest Oncol. 2023 Apr 29;14(2):1037-1051. doi: 10.21037/jgo-23-33. Epub 2023 Apr 12.
Chemotherapy plays an important role in definitive chemoradiotherapy strategies. However, the most optimal concurrent chemotherapy scheme is still controversial. This study aimed to systematically evaluate the efficacy and toxicity of paclitaxel/docetaxel combined with platinum (PTX) and fluorouracil combined with cisplatin (PF) in the concurrent chemoradiotherapy (CCRT) of unresectable esophageal cancer.
The PubMed, China National Knowledge Infrastructure (CNKI), Google Scholar and Embase databases were searched by combining subject words and free words through December 31, 2021. The inclusion criteria were pathologically confirmed esophageal cancer studies using CCRT, where the chemotherapy regimen only compared PTX and PF. Quality evaluation and data extraction of studies that met the inclusion criteria were carried out independently. Stata 11.1 software was used to perform the meta-analysis. The begger analysis and egger analysis were used to assess publication bias, and the robustness of the pooled results further assessed by the Trim and Fill analysis.
After screening, 13 randomized controlled trials (RCTs) were included. A total of 962 cases were enrolled, including 480 (49.9%) in the PTX group and 482 (50.1%) in the PF group. The gastrointestinal reaction to the PF regimen was the most serious [relative risk (RR) =0.54, 95% confidence interval (CI): 0.36-0.80, P=0.003]. The complete remission (CR) rate, objective response rate (ORR), and disease control rate (DCR) of the PTX group were higher than those of the PF group (RR =1.35, 95% CI: 1.03-1.76, P=0.030; RR =1.12, 95% CI: 1.03-1.22, P=0.006; RR =1.05, 95% CI: 1.01-1.09, P=0.022). In terms of the overall survival (OS) rate, the 2-year survival rates of the PTX group were higher than those of the PF group (P=0.005). There was no significant difference in the 1-, 3-, and 5-year survival rates between the two regimens (P=0.064, 0.144, and 0.341, respectively). There may be publication bias for ORR and DCR, and the results are reversed after applying the Trim and Fill method, so the combined results are not robust.
PTX may be the preferred regimen for CCRT of esophageal squamous cell carcinoma, with better short-term therapeutic effect and 2-year OS rate and lower gastrointestinal toxicity.
化疗在确定性放化疗策略中发挥着重要作用。然而，最优的同步化疗方案仍存在争议。本研究旨在系统评价紫杉醇/多西他赛联合铂类（PTX）与氟尿嘧啶联合顺铂（PF）在不可切除食管癌同步放化疗（CCRT）中的疗效和毒性。
通过结合主题词和自由词检索PubMed、中国知网（CNKI）、谷歌学术和Embase数据库，检索截至2021年12月31日的文献。纳入标准为经病理证实的采用CCRT的食管癌研究，其中化疗方案仅比较PTX和PF。对符合纳入标准的研究进行独立的质量评估和数据提取。使用Stata 11.1软件进行荟萃分析。采用Begger分析和Egger分析评估发表偏倚，并通过Trim和Fill分析进一步评估合并结果的稳健性。
筛选后，纳入13项随机对照试验（RCT）。共纳入962例患者，其中PTX组480例（49.9%），PF组482例（50.1%）。PF方案的胃肠道反应最为严重[相对危险度（RR）=0.54，95%置信区间（CI）：0.36 - 0.80，P = 0.003]。PTX组的完全缓解（CR）率、客观缓解率（ORR）和疾病控制率（DCR）均高于PF组（RR = 1.35，95% CI：1.03 - 1.76，P = 0.030；RR = 1.12，95% CI：1.03 - 1.22，P = 0.006；RR = 1.05，95% CI：1.01 - 1.09，P = 0.022）。在总生存（OS）率方面，PTX组的2年生存率高于PF组（P = 0.005）。两种方案的1年、3年和5年生存率无显著差异（分别为P = 0.064、0.144和0.341）。ORR和DCR可能存在发表偏倚，应用Trim和Fill方法后结果反转，因此合并结果不稳健。
PTX可能是食管鳞状细胞癌CCRT的首选方案，具有较好的短期治疗效果和2年OS率，且胃肠道毒性较低。
