术前放疗对可切除直肠癌患者远期生存影响的荟萃分析

Effect of Long-term Survival of Patients with Resectable Rectal Cancer by Preoperative Radiotherapy:a Meta-analysis

目的 评估术前放疗对可切除直肠癌患者远期生存率的影响,探讨术前放疗在可切除直肠癌患者中的临床应用价值.方法 通过在Pubmed及CNKI数据库中检索＂术前放疗＂和＂直肠癌＂的相关研究,抽取及计算直肠癌术前放疗与单纯手术生存率的比值比（OR）和95% CI,运用荟萃分析估算汇总的OR值及95% CI,并对纳入的研究进行分层分析及发表偏倚的检验.结果 发表于1990年至2013年间的17篇文献纳入到本研究中,包括4 489例术前放疗患者和4 521名单纯手术患者,术前放疗的总剂量在15~50 Gy之间.和单纯手术组比较,术前放疗可显著延长直肠癌术后患者的生存时间,汇总后OR值为1.18（95% CI为1.08~1.29）.分层分析显示在亚洲人群和使用常规分割放疗方式,术前放疗在延长直肠癌术后患者的生存时间方面,未显示出明显的统计学意义.结论 直肠癌根治术前辅助放疗可提高可切除直肠癌患者的远期生存率,具有较高的临床应用价值.

Objective To evaluate the effect of the long-term survival of patients with resectable rectal cancer by preoperative radiotherapy, and to study the clinical value of preoperative radiotherapy in patients with rectal cancer. Methods Through searching the relevant studies by the key words of ＂preoperative radiotherapy＂ and ＂rectal cancer＂ in Pubmed and CNKI database, extracting or calculating the value of odds ratio （OR）and 95% confidence interval （CI） in the preoperative radiotherapy combined surgery group and the surgery alone group. The pooled OR, 95 % CI were analyzed, and the stratification analysis and the test of publication bias were analyzed too. Results There were 17 eligible studies （from 1990 to 2013 ）in this mata-analysis. The total number of patients in the preoperative radiotherapy combined surgery group was 4 489 and there was 4 521 patients in the surgery alone group. The total dose of preoperative radiotherapy in these studies was 15 to 50 Gy. Compared with the patients who had surgery alone, preoperative radiotherapy can prolong their long-term survival significantly with the pooled OR （1. 18,95 % CI： 1.08-1.29）. In the stratification analysis, the result showed the preoperative radiotherapy could＇ t prolong the survival of patients with rectal cancer significantly in the asian population and with conventional fractionation. Conclusion Preoperative radiotherapy can prolong the long-term survival of patients with resectable rectal cancer significantly, compared with the patients who conducted surgery alone, preoperative radiotherapy has the higher clinical value in patients with resectable rectal cancer.