宫颈癌新辅助化疗的Meta分析

Neoadjuvant chemotherapy followed by surgery versus surgery alone for cervical cancer:a meta-analysis

目的:评价新辅助化疗在宫颈癌治疗中的作用。方法:计算机检索PUBMED,MEDLINE及万方、中国科技期刊数据库。手工检索山东大学图书馆和齐鲁医院图书馆1990年以后的妇科肿瘤方面的杂志。语种限英语和汉语。试验组为新辅助化疗联合手术的宫颈癌患者,有或无放疗,对照组单纯手术,有或无放疗。采用ReviewManager4.2软件进行Meta分析。以患者的生存率、复发率、转移率为观察指标,通过合并相对危险度(RR)比较新辅助化疗组与对照组的3年总生存率(OS)及无进展生存率(DFS)、5年OS及DFS、复发率、转移率。结果:共有13项研究2449例患者符合纳入标准。结果显示,新辅助化疗联合手术组较单纯手术组:①3年OS无差异(RR=1.09,95%CI:0.97～1.23,P=0.15)。②3年DFS无差异(RR=1.12,95%CI:0.99～1.26,P=0.07)。③5年OS提高(RR=1.09,95%CI:1.03～1.16,P=0.05);④5年DFS提高(RR=1.15,95%CI:1.04～1.26,P=0.004)。⑤复发率降低(RR=0.72,95%CI:0.58,0.88,P=0.002)。⑥转移率降低(RR=0.49,95%CI:0.30～0.80,P=0.04)。结论:新辅助化疗能够降低复发率和转移率,提高患者的5年OS及DFS。

Objective：To assess the efficacy of neoadjuvant chemotherapy followed by surgery in patients with cervical cancer, nethods：A systematic review of neoadjuvant chemotherapy followed by surgery was performed by searching various databases, including PUBMED, MEDLINE, China National Knowledge infrastructure and the Wan Fang database. Gynecological carcinoma-related journals in the library of Shandong University and Qilu Hospital were searched manually. Languages was restricted to Chinese and English. Data including overall survival, disease- free survival, recurrence and metastasis were extracted from both the NACT and control groups. The results of similar trials were combined, and relative risk was used to express the results for the categorical variables. Results： Thirteen trials involving 2 449 patients were included in the study. Compared with the control group, the NACT group ①did not have any apparent increase in the 3-year overall survival（OS）（RR=1.09,95%CI：0.97-1.23,P=0.15）, ② did not have an increase in their 3-year disease-free survival （DFS）（RR=1.12,95%CI：0.99-1.26,P=0.07）, ③did have an increase in 5-year OS （RR=1.09,95%CI：1.03-1.16,P=0.05）, ④had an increase in their 5-year DFS （RR=1.15,95%CI： 1.04-1.26,P=0.004）,⑤had a decrease in the rate of recurrence （RR=0.72,95%CI：0.58-0.88,P=0.002）, and ⑥had a decreased rate of metastasis （RR=0.49,95%CI：0.30-0.80,P=0.04）. Conclusion： Neoadjuvant chemotherapy followed by surgery can eliminate pathological risk factors and improve the long-term prognosis for patients.