放、化疗治疗局部晚期鼻咽癌的Meta分析

Neoadjuvant chemotherapy,adjuvant chemotherapy and radiotherapy or their combinations for nasopharyngeal cancer:a Meta-analysis on randomized controlled trials

目的比较放、化疗综合治疗与单纯放疗在局部晚期鼻咽癌(nasopharyngeal carcinoma,NPC)患者中的疗效,分析两者在死亡率(mortality rate,MR)、无事件生存率(event-free survival,EFS)、局部复发率(local recurrence rate,LRR)及远处转移率(distant metastasis rate,DMR)的差别,以进一步明确放、化疗综合治疗在局部晚期NPC中的作用。方法根据制定的文献纳入标准,选择已发表的临床随机对照研究进行Meta分析。结果本研究共纳入16项临床研究,累计3768例患者。同期放化疗组患者的2、3、5年MR、EFR、LRR及DMR均较单纯放疗组显著改善(P<0.01)。与单纯放疗组相比,诱导化疗组的LRR及DMR亦较低(P<0.05)。而辅助化疗组与单纯放疗组相比,OS、EFR、LRR和DMR都没有统计学差异(P>0.05)。结论放、化疗综合治疗(尤其是同期放、化疗)与单纯放疗相比,能更好的改善NPC患者的生存率,并降低其LRR和DMR,是治疗局部晚期NPC的有效方法。

Objective To compare the beneficial efficiency of chemotherapy combined with radiotherapy or radiotherapy alone, for locally advanced nasopharyngeal carcinoma. Methods A systematic review of randomized controlled trials （RCT） on this subject was performed. Mortality rate （MR）, event-free survival （EFS） , loco-regional control rate （LRR） and distant metastasis rate （DMR） were analyzed. Meta-analysis was carried out to compare the efficiency of adding chemotherapy to radiotherapy or radiotherapy alone. Results Totally 16 trials involving 3 768 patients were included. Our results showed that ： （1） Patients receiving concomitant chemotherapy had better 2-, 3- and 5-year MR, EFS, LRR and DMR compared with those receiving radiotherapy alone ;（2） Neoadjuvant chemotherapy improved LRR and DMR in patients with nasopharyngeal carcinoma when compared with radiotherapy alone;（3） There was no significant difference between adjuvant chemotherapy and radiotherapy alone in MR, EFS, LRR and DMR. Conclusion Adding chemotherapy to radiotherapy improves survival rate and EFS of patients with nasopharyngeal carcinoma, reduces LRR and DMR of these patients when compared with radiotherapy alone. We believe that adding chemotherapy to radiotherapy is a very effective therapy for patients with locally advanced nasopharyngeal carcinoma.