术前新辅助放化疗与单纯手术对可切除食管癌疗效的Meta分析

Effect of pre-operative neoadjuvant chemo-radiotherapy and surgical treatment on resectable esophageal cancer: a Meta-analysis

目的探讨术前新辅助放化疗在可切除食管癌治疗中的作用。方法通过计算机检索Medline、CENTRAL（the Cochrane central register of controlledtrials）、EMBASE、中国生物医学文献数据库系统（CBM）、中国期刊全文数据库（CNKI）,收集国内外公开发表的关于可切除食管癌新辅助放化疗后行手术治疗与单纯手术治疗比较的随机对照试验（RCTs）,应用统计软件STATA11.0进行结果分析。研究人群为可切除的早中期食管癌患者,干预措施为术前行新辅助放化疗（包括续贯放化疗和同期放化疗）后再行手术治疗,结局指标为13、年生存率和局部复发率,并分别以比值比（OR）、相对危险度（RR）及各自的95%可信区间作为效应指标对结局进行比较。结果最终纳入分析的文献共9篇,包括1156例患者,其中579例行新辅助放化疗后再行手术治疗,577例行单纯手术治疗。新辅助放化疗组与单纯手术组比较的13、年生存率比值比分别为OR=1.06（95%CI=0.94~1.19,Z=0.97,P=0.33）和OR=1.30（95%CI=1.07~1.57,Z=2.67,P=0.008）,两组术后局部复发比较的相对危险度RR=0.75（95%CI=0.50~1.12,Z=1.40,P=0.162）。结论术前新辅助放化疗可提高可切除食管癌患者的3年生存率,但不能明显降低术后局部复发率。

Objective To explore the effect of pre-operative adjuvant chemo-radiotherapy and surgical treatment on resectable esophageal cancer.Methods By searching Medline,CENTRAL（the Cochrane Central Register of Controlled trials）,EMBASE,CBM（China Biology Medicine） and CNKI（China National Knowledge Infrastructure） by computer,the data of randomized controlled trials（RCTs） of neoadjuvant chemoradiotherapy and surgical treatment for resectable esophageal cancer were selected and analyzed using Stata 11.0 statistical software.The study population was patients with resectable early or medium stage esophageal cancer,the intervention was neoadjuvant chemoradiotherapy（include sequential chemoradiotherapy and concurrent chemoradiotherapy） followed with surgical resection,the outcome indices were 1-and 3-year survival rates and local recurrence rate.The combined odds ratio（OR）,relative risk（RR） and their 95% confidence interval（CI） were calculated to estimate the results.Results Nine articles including a total of 1156 patients were finally analyzed in the Meta-analysis.Among all the patients,579 received neoadjuvant chemoradiotherapy（study group） and 577 received surgical treatment only（control group）.Compared the study group and control group,the OR of 1-and 3-year survival rate was 1.06（95%CI=0.94-1.19,Z=0.97,P=0.33） and 1.30（95%CI=1.07.-1.57,Z=2.67,P=0.008）,respectively,and the RR of local recurrence rate was 0.75（95%CI=0.50-1.12,Z=1.40,P=0.162）.Conclusions Neoadjuvant chemoradiotherapy could improve the 3-year survival rate of patients with resectable esophageal cancer,but could not decrease the local recurrence rate.