同期化放疗联合辅助化疗治疗局部晚期鼻咽癌Meta分析

The Role of Concurrent Chemoradiotherapy plus Adjuvant Chemotherapy to Radiotherapy Alone in the Treatment of Locally Advanced Nasopharyngeal Carcinoma： A Meta-analysis

目的探讨同期化放疗联合辅助化疗在局部晚期鼻咽癌中的作用。方法按照预先设计的荟萃分析方案，选择已发表的Ⅲ期随机对照临床研究。比较鼻咽癌病人同期化放疗联合辅助化疗与单纯放疗的总生存率、疾病的局部控制率及远处转移率。结果与单纯放疗组相比，同期化放疗联合辅助化疗组病人的2年、3年和5年的总生存OR分别为0．57（95％CIO．41—0．78）、0．44（95％C10．24—0．80）和0．43（95％CIO．19-0．93），而其相应的2年、3年和5年的绝对生存获益分别为8％、12％和13％，其5年局部复发率及远处转移率的OR分别为0．40（95％C10．25。0．65）和0．51（95％C10．37～0．70）。结论同期化放疗联合辅助化疗是改善鼻咽癌患者总生存最有效的方法之一。

Objective To investigate the value of concurrent chemoradiotherapy plus adjuvant chemotherapy（CCRT plus AC） to radiotherapy alone in the treatment of locally advanced nasopharyngeal carcinoma（NPC）.Methods Using a prospective meta-analysis protocol fully published randomized trials for which patients with NPC were randomly assigned to receive radiotherapy alone or radiotherapy combined with chemotherapy was selected.The overall survival（OS） and the incidence of locoregional control and distant metastasis were compared.Results Seven randomized clinical studies including 1,337 patients were selected in this meta-analysis.OR of 0.57（95%CI,0.41 ~ 0.78）,corresponding with absolute survival benefit of about 8%,0R of 0.44（95%CI,0.24- 0.80）,corresponding with absolute survival benefit of about 12% and OR of 0.43（95%CI,0.19 - 0.93） corresponding with absolute survival benefit of about 13% for CCRT plus AC group were observed for 2-year,3-year and 5-year overall survival respectively.OR of 0.40（95%CI,0.25 ~ 0.65）for 5-year LLR and OR of 0.51（95%CI,0.37 - 0.70）for 5-year DM after being observed.Conclusion Concurrent chemoradiotherapy plus adjuvant chemotherapy is the most effective way to improve OS in patients of NPC.