氟尿嘧啶缓释剂治疗结直肠癌的系统评价

Fluorouracil implants for colorectal cancer： a systematic review and meta-analysis

目的评价氟尿嘧啶（5-FU）缓释剂对结直肠癌的治疗作用和安全性。为临床用药提供依据。方法计算机检索CBM、中国期刊全文数据库、中国科技期刊全文数据库、万方数字化期刊全文库、Cochrane对照试验中心注册库、Medline和Embase数据库，检索日期为建库始至2011年3月，筛选5-FU缓释剂与结直肠癌相关文献．只纳入随机对照试验。根据Cochrane评价员手册5．02评价纳入研究的偏倚风险。采用RevMan5．0软件进行统计分析。结果共纳入16篇随机对照试验的1223例研究对象，偏倚风险中等。Meta分析结果显示，5．Fu缓释剂组术后2年死亡率（RR=0．33，95％CI：0．18-0．59）、2年转移率（RR=0.35，95％CI：0．19-0．66）和2年复发率（RR=0.48，95％CI：0．36=0．65）均低于对照组：但两组治疗后并发症和不良反应发生率的差异无统计学意义（P〉0.05）。结论5-FU缓释剂可有效改善结直肠癌患者的预后．而不会加重不良反应。但纳入研究的质量有待提高。

Objective To evaluate the benefit and safety of fluorouracil implants on colorectal cancer. Methods Based on the methods of Cochrane systematic reviews, databases including CBM （1982 to March 2011）, CNKI （1911 to March 2011）, EMBASE （1966 to March 2011）, and Medline （1950 to March 2011） were searched to identify randomized controlled trials assessing the benefit of fluorouracil implants on colorectal cancer. The quality of the included studies was assessed using the Cochrane＇s tool for assessing bias. RevManS.0 was used for meta-analysis. Results Sixteen studies were included （n=1223）. The quality of included studies was moderate. Fluorouracil implants could reduce the 2-year mortality（RR=0.33. 95% CI：0.18-0.59）, 2-year metastasis rate（RR=0.35, 95% CI： 0.19-0.66）, and 2-year recurrence rate （RR=0.48, 95% CI：0.36-0.65）. There were no significant differences in complications and adverse effects between fluorouracil implants and the control group. Conclusions Current evidence demonstrates that fluorouracil implants may modestly improve the outcome of colorectal cancer patients without increasing its adverse events. However, the results should be interpreted with caution due to the risk of bias of included studies.