术前放疗联合手术治疗食管癌的Meta分析

Preoperation radiotherapy combined with surgical treatment for esophageal cancer:A Meta-analysis

目的评价术前放疗联合手术与单纯手术比较治疗食管癌的有效性及安全性。方法计算机检索PubMed(1966-2009年),EMBASE(1974-2009年),Cochrane图书馆(2009年第4期),CNKI(1994-2009年),CBM(1978-2009年),VIP(1989-2009年)和万方数据(1997-2009年)等数据库。纳入术前放疗联合手术治疗食管癌的相关临床随机对照试验(RCT),由2位研究者独立进行资料提取和质量评价。采用Revman5.0统计软件进行Meta分析。结果最终纳入10个RCT,共2706例患者。Meta分析结果显示:术前放疗联合手术与单纯手术治疗相比,其1年总生存率[RR=1.17,95%CI1.07～1.28,P=0.0004]、5年总生存率[RR=1.18,95%CI1.01～1.37,P=0.03]、手术切除率[RR=1.08,95%CI1.05～1.11,P<0.01]、断端残癌阳性率[RR=0.18,95%CI0.08～0.41,P<0.01]和淋巴结转移率[RR=0.60,95%CI0.43～0.84,P=0.003]差异均有统计学意义。但在3年总生存率[RR=1.54,95%CI0.97～2.45,P=0.07]和术后吻合口瘘发生率[RR=0.74,95%CI0.33～1.66,P=0.47]方面,均无统计学差异。结论与单纯手术相比,术前放疗联合手术可提高食管癌患者1年总生存率、5年总生存率和手术切除率,降低断端残癌阳性率和淋巴结转移率。但其在3年总生存率和术后吻合口瘘发生方面尚无差异,需高质量RCT进一步证实。

Objective To assess the effectiveness and safety of preoperation radiotherapy combined with surgery for esophageal cancer. Methods Relevant randomized controlled trails （RCT） were retrieved from PubMed （1966-2009）,EMBASE （1974-2009）,Cochrane Library （Issue 4,2009）,CNKI （1994-2009）,CBM （1978-2009）,VIP（1989-2009） and WanFang （1997-2009）. Two researchers assessed the quality of included trials and extracted data independently. Revman 5.0 software was used for meta-analysis. Results Ten RCTs of 2706 patients were involved in this Meta-analysis. The results show：preoperative radiotherapy combined with surgery compared with surgery alone：there were differences of 1 year overall survival rate [RR=1.17,95%CI 1.07-1.28,P=0.000 4],5 year overall survival rates [RR=1.18,95%CI 1.01-1.37,P=0.03],surgical resection rate[RR=1.08,95%CI 1.05-1.11,P0.01],stump-positive rate of residual cancer[RR=0.18,95%CI 0.08-0.41,P0.01] and lymph node metastasis rate[RR=0.60,95%CI 0.43-0.84,P=0.003] between the two groups. However,there was no difference of 3 years overall survival rates [RR=1.54,95%CI 0.97-2.45,P=0.07] and the incidence of postoperative anastomotic leakage[RR=0.74,95%CI 0.33-1.66,P=0.47]. Conclusion Compared with surgery alone,preoperative radiotherapy combined with surgery in patients with esophageal cancer can improve the 1-year overall survival,5-year overall survival rates and surgical resection rate,reducing stump positive rate of residual cancer and lymph node metastasis rate. However,There was no significant difference in 3-year overall survival rates and the incidence of postoperative anastomotic leakage.Therefore,we looking forward to high-quality RCTs to reveal the significance of the combined treatment of preoperation radiotherapy combined with surgery.