新辅助化疗结合放疗与单纯放疗治疗局部晚期宫颈癌疗效比较的Meta分析

Combination of neoadjuvant chemotherapy and radiotherapy VS radiotherapy alone in locally advanced cervix cancer:a cumulative meta-analysis

目的比较新辅助化疗结合放疗与单纯放疗治疗局部晚期宫颈癌的疗效,并累计数据分析Meta分析结果开始的时间。方法采用Meta分析对国内外已发表的有关新辅助化疗结合放疗治疗局部晚期宫颈癌的相关文献进行综合分析,计算机检索MEDLINE(1982～2009.4),EMBASE(1982～2009.4),The Cochrane Central Register of Controlled Trials(CENTRAL,1stQuarter2009),CBM(1982～2009.4),CNKI(1982～2009.4),VIP(1982～2009.4),万方(1982～2009.4),手工检索北大核心期刊收录的5本妇产科杂志(中华妇产科杂志、中国实用妇科与产科杂志、实用妇科杂志、生殖与避孕、现代妇科进展),并检索纳入文献的参考文献。选择治疗组为新辅助化疗结合放疗,对照组为单纯放疗的局部晚期宫颈癌的随机对照试验。由2位评价者分别收集资料,按纳入标准入选,主要对总病死率进行Meta分析,同时对数据进行累计Meta分析趋势开始时间。结果共纳入13篇文献的14个研究。在治疗局部晚期宫颈癌方面,新辅助化疗后放疗与单纯放疗相比较,能够降低患者总病死率(P=0.008<0.05,95%CI=[0.52,0.90]);累积Meta分析显示这种趋势从1998年就已经开始。结论新辅助化疗适用于局部晚期宫颈癌的治疗,与放疗结合使用能够降低患者总病死率,且这种疗效在10年前就已经有证据开始支持。

Objective To compare the effect of neoadjuvant chemotherapy combined with radiotherapy with radio thera-py alone for locally advanced cervical cancer,and to systematically evaluate the time when the method markedly worked.Methods We retrieved MEDLINE（1982-2009.4）,EMBASE（1982-2009.4）,CBM（1982-2009.4）,CNKI（1982-2009.4）,VIP（1982-2009.4）,Wanfang Datebase（1982-2009.4）and 5 journals of obstetrics and gynecology （Chinese Journal of Obstetrics and Gynecology,Chinese Journal of Practical Gynecology and Obstetrics,Gynecology and Practical Magazine,Reproductive and Contraceptive,The Progress of Modern Gynecology） and references of included literatures.The experiment group was treated with combination of neoadjuvant chemotherapy and radiotherapy and the control group was treated with radiotherapy alone.All patients suffered from locally advanced cervix cancer.A quantitative meta-analysis using updated information based on inclusion criterion from all available randomized controlled trials was conducted by 2 reviewers.Primary meta-analysis was based on case-fatality rate.The cumulative meta-analysis was done to find out when the trend had started.Results The meta-analysis included 14 randomized controlled trials.Radiotherapy after neoadjuvant chemotherpy could improve the overall survival rate in patients of cervical cancer compared with radiotherapy alone （P=0.0080.05,95%CI=[0.52,0.90]）.Cumulative meta-analysis showed that this trend started since 1998.Conclusion Neoadjuvant chemotherapy combined with radiotherapy for locally advanced cervical cancer is effective,and there was evidence to support the conclusion as early as 10 years ago.