新辅助化疗联合同期放化疗与同期放化疗单独治疗鼻咽癌疗效及安全性的Meta分析

Comparison of neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemora diotherapy alone in locoregionally advanced nasopharyngeal carcinoma: A meta analysis

目的评价新辅助化疗联合同期放化疗(IC+CCRT)治疗局部进展期鼻咽癌的疗效及安全性。方法计算机检索pubmed、embase、cochrane图书馆、CNKI等数据库有关IC+CCRT与CCRT治疗鼻咽癌的随机对照试验,按照事先设置的标准由两位研究者独立进行筛选、提取相关资料并用RevMan5.1.0软件进行分析。结果 10项RCT共921例患者纳入本研究。Meta分析结果显示,与CCRT相比:①近期疗效:IC+CCRT即期颈部淋巴结完全缓解率提高[OR=2.53,95%CI(1.44,4.44),P=0.001],而鼻咽部肿瘤完全缓解率两者差异无统计学意义[OR=1.26,95%CI(0.66,2.40),P=0.16];治疗结束3个月后IC+CCRT鼻咽部肿瘤及颈淋巴结完全缓解率均较前者有所提高[RR=1.07,95%CI(1.02,1.14),P=0.01],[RR=1.11,95%CI(1.02,1.21),P=0.01];②远期疗效:2年总生存率两者差异无统计学意义[OR=1.04,95%CI(0.97,1.12),P=0.25];③安全性:IC+CCRT治疗过程中除Ⅲ°及以上白细胞下降情况明显外[RR=1.57,95%CI(1.24,1.98),P=0.000 2],其余Ⅲ°及以上皮肤反应[RR=1.57,95%CI(0.91,1.96),P=0.14]、口腔黏膜反应[RR=1.13,95%CI(0.95,1.34),P=0.18]和消化道不良反应[RR=0.99,95%CI(0.72,1.37),P=0.95]两者差异无统计学意义。结论与CCRT相比,IC+CCRT可以提高近期疗效,但对2年远期总生存率无明显益处,且后者治疗期间白细胞下降更明显。

Objective To evaluate the efficacy and treatment toxicity of neoadjuvant chemotherapy followed by concur- rent chemoradiotherapy compared with concurrent chemoradiotherapy alone in the treatment of locoregionally advanced nasopharyngeal carcinoma. Methods The search strategy included Pubmed （ 1978-2013 ）, Embase （ 1978-2013 ）, the Cochrane Library, China National Knowledge Internet Web （ 1978-2013 ）, Vipbrowser Database （ 1978 -2013 ） and Wan- fang Database（ 1978-2013 ）. We also searched reference lists of articles as a complement. RCTs that compared neoadju- vant chemotherapy followed by concurrent chemoradiotherapy（IC ＋ CCRT） with concurrent chemoradiotherapy（CCRT） alone in locoregionally advanced nasopharyngeal carcinoma were included. After study selection, two reviewers assessed and extracted data independently. Meta-analysis was performed by using the RevMan 5.1.0. software. Results Four studies were included in immediate result of treatment evaluation ： compared with CCRT, IC ＋ CCRT got more complete response of cervical lymph nodes [ OR = 2. 53, 95 % CI （ 1.44,4. 44 ） ], but had no significant difference between the two groups in the CR of primary lesions （P 〈 0.05）. Five studies were included in the short-term efficacy evaluation： compared with the CCRT, IC ＋ CCRT got more complete response of primary lesions and cervical lymph nodes E OR = 1.07, 95 % CI（ 1.02,1. 14） ], t OR = 1.11, 95% CI（ 1.02,1.21 ） ]. Six studies were included in 2 years overall survival evaluation ： there had no significant difference between the two groups （ P 〉 0.05 ）. There were no treat- ment-related deaths in both groups of six studies. Ten studies were included in treatment toxicity evaluation： Risk ratios of [OR=1.57, 95%CI（1.24,1.98）], [OR=1.34, 95%CI（0.91,1.96）], [OR=1.13, 95%CI（0.95,1.34）], E OR = 0.99, 95 % CI（O. 72,1.37 ） %. were observed for leucopenia, dermatitis, mucositis, and gastrointestinal toxicity during the treatment. Conclusion The neoadjuvant chemotherapy followed by concurrent chemoradiotherapy can im-prove the short-term efficacy of treatment but increases the treatment toxicity in local advanced nasopharyngeal carcino- ma, and it cannot improve the immediate result and 2-year survival.