系统评价宫颈癌术前应用新辅助化疗的临床价值

Clinical value of neoadjuvant chemotherapy before surgery for cervical cancer： A Meta-analysis

目的系统评价新辅助化疗用于宫颈癌手术治疗前的临床价值。方法网上检索MEDLINE、PUBMED、ELSEVIER Science Direct、CNKI、CBMdisc、Cochrane Library and EMBASE，获取全文。筛选临床研究文献，试验组是新辅助化疗联合手术，对照组是直接手术，提取用于评价的指标包括：淋巴结转移、脉管浸润、间质浸润、切缘阳性率、3年生存率（OS）、3年无瘤生存率（DFS）、5年生存率、5年无瘤生存率，并进行Meta分析。结果新辅助化疗组与对照组相比，淋巴结转移的HR和95％CI分别为（0．52，0．42～0．64，P〈0．0001），间质浸润的分别为（0．41，0．32～0．55，P〈0．0001），脉管浸润的分别为（0．25，0．16～0．38，P〈0．0001），切缘阳性率的分别为（0．44，0．22—0．87，P=0．02），差异均有统计学意义；3年0S的HR和95％CI分别为（1．11，0．85～1．46，P=0．46），3年DFS的分别为（1．45，1．10～1．91，P=0．008），5年OS的分别为（1．11，0．87—1．40，P=0．40），5年DFS的分别为（1．33，1．05～1．77，P=0．04），3年DFS和5年DFS的差异有统计学意义，而3年OS和5年OS的差异无统计学意义。结论宫颈癌术前应用新辅助化疗能减少预后不良相关病理因素，对改善患者的生存可能有益。

Objective To evaluate clinical value of neoadjuvant chemotherapy（NACT） before surgery for cervical cancer. Methods The author searched the clinical trials on the treatment of cervical cancer comparing NACT followed by surgery versus initial surgery in the main medical data resources（ MEDLINE,PUBMED, ELSEVIER ScienceDirect,CNKI,CBMdisc,Cochrane Library and EMBASE） published in English and Chinese literature. We abstracted data about positive pelvic nodes, interstitial infiltration, vascular invasion, positive surgical margin,3-year overall survival （OS） ,3-year disease-free survival（DFS） ,5-year OS,5-year DFS from both NACT group and control group, and a meta-analysis was applied. Results The hazard ratio （HR） of positive pelvic nodes on NACT group versus control group was 0. 52 （95% CI 0. 42 - 0.64, P 〈 0. 0001 ）, HR of interstitial infiltration was 0.41 （95 % CI 0. 32 - 0. 55, P 〈 0. 0001 ）, HR of vascular invasion was 0. 25 （95 % CI 0. 16 - 0. 38, P 〈 0. 0001 ）, and HR of positive surgical margin was 0. 44 （ 95% CI 0.22 N 0. 87, P = 0.02 ）, all differences were statistically significant. And there were significant difference on the HRs of 3-year DFS, and 5-year DFS,which were 1.45 （95% CI 1.10 - 1.91, P = 0. 008）and 1.33 （95% CI 1.05 - 1.77,P = 0. 04）. And there were no significant difference on HRs of 3-year OS and 5-year OS, which were 1.11 （95% CI 0. 85 - 1.46, P = 0.46）and 1.11（95%CI 0. 87 - 1.40,P = 0. 40） respectively. Conclusion For cervical cancer,NACT could reduce pathological risk factors and maybe improve prognosis.