术后化疗联合放疗对间变性少突胶质细胞瘤预后影响的系统评价

Systematic review of effects for chemotherapy combined with radiotherapy of anaplastic oligodendroglioma afear operation

目的系统评价间变性少突胶质细胞瘤综合治疗中化学疗法(化疗)联合放射疗法(放疗)疗效及预后因素。方法计算机检索MEDLINE(1966—2009-03)、EMBASE(1984—2009)、THE COCHRANECENTRAL图书馆、OVID(1970—2009-03)和中国生物医学文献数据库,并手工检索相关中文杂志,收集国内外与间变性少突胶质细胞瘤化疗有关的临床随机对照试验(RCT),对文献进行质量评价。采用RevMan4.2.8软件进行Meta分析。结果共纳入2篇临床RCT文献。Meta分析结果显示:丙卡巴肼、洛莫司汀和长春新碱进行联合化疗(PCV联合化疗方案),可提高间变性少突胶质细胞瘤的5年无进展生存率(PFS)[OR=2.12,95%CI(1.50,2.99),P<0.01],但对5年总体生存率(OS)无显著影响[OR=1.33,95%CI(0.98,1.81),P=0.07]。1号染色体短臂(1p)及19号染色体短臂(19q)染色体杂合子缺失(LOH)的间变性少突胶质细胞瘤亚组的5年PFS与OS均较非缺失的亚组高(P<0.01)。具有1p及19q染色体LOH的间变性少突胶质细胞瘤PCV联合化疗可提高其5年PFS,但未提高其5年OS。结论 PCV联合化疗可提高间变性少突胶质细胞瘤患者的5年PFS,1p及19q染色体杂合子缺失是间变性少突胶质细胞瘤有利的预后因素。

AIM To assess systematically the outcome of therapies and prognostic factors for anaplastic oligodendroglioma.METHODS A systematic literature search was performed for articles describing the chemotherapy of anaplastic oligodendroglioma（Medline,Embase,Cochrane Central Library,OVID and CBM）,and the relevant Chinese neurosurgical journals were manually looked up.Randomized controlled trials（RCTs） and clinical controlled trials of chemotherapy for anaplastic oligodendroglioma were included.The quality of trials was critically assessed.Meta analysis was performed using RevMan 4.2.8 software.RESULTS Two RCTs of chemotherapy plus radiotherapy versus radiotherapy alone for anaplastic oligodendroglioma were included.The results of Meta-analysis showed that adjuvant procarbazine,lomustine,and vincristine for anaplastic oligodendroglioma increased the progression-free survival（PFS） [OR = 2.12,95%CI（1.50,2.99）,P 0.01].The difference of overall survival failed to show statistically significance between the two protocols [OR = 1.33,95%CI（0.98,1.81）,P = 0.07].PFS and OS in subgroup with the combined loss of 1p / 19q were higher than that in subgroup without the combined loss of 1p / 19q（P 0.01）.Adjuvant PCV chemotherapy did not improve OS but increased PFS in the subgroup with the combined 1p / 19q loss.CONCLUSION Adjuvant PCV chemotherapy does not prolong OS but does increase PFS in anaplastic oligodendroglioma.Combined loss of 1p / 19q identifies a favorable subgroup of oligodendroglial tumors.