新辅助化疗治疗食管癌疗效及安全性的Meta分析

A Meta- analysis of neoadjuvant chemotherapy and surgery alone for esophageal neoplasms

目的:系统评价新辅助化疗与单纯手术治疗食管癌的疗效与安全性。方法:计算机检索Pub Med、EMBASE、The Cochrane Library、Web of Science、中国生物医学文献数据库、万方数据库、中国期刊全文数据库、中文科技期刊数据库,同时辅以手工检索,收集所有比较新辅助化疗与单纯手术治疗食管癌的随机对照试验(RCTs)。采用Cochrane协作网提供的Rev Man 5.2软件进行统计分析。结果:共纳入13个RCTs,新辅助化疗组(CS组)、单纯手术组(S组)及新辅助放疗组共3295例,Meta分析结果显示两组患者的根治切除率差异有统计学意义,其RR(95%CI)为1.20(1.13,1.27)。3年生存率、5年生存率方面差异有统计学意义,其RR(95%CI)分别为1.16(1.03,1.30)、1.21(1.06,1.39)。无病生存期差异有统计学意义,其RR(95%CI)为1.33(1.22,1.46)。1年生存率、围手术期死亡率差异无统计学意义。结论:与单纯手术相比,新辅助化疗提高了食管癌患者的根治性切除率,可使患者生存获益。

Objective：To evaluate the efficacy and safety of neoadjuvant chemotherapy（ CS group）or surgery alone （S group）in the treatment of resectable esophageal neoplasms. Methotls： Medline and manual searches was conducted in PubMed, Cochrane Library, EMbase, CBM Database, CNKI Database, VIP Database and Wanfang Database. The se- lection contents were to identify all published and unpublished RCTs that compared neoadjuvant chemotherapy and surgery with surgery alone for resectable esophageal neoplasms. Meta - analysis was conducted by using RevMan 5.2 software. Results：Thirteen RCTs which included 3295 patients were selected. There were significant diferences be- tween CS group and S group in radical resection rate,3 -year survival rate ,5 -year survival rate, disease free survival ; the RR value and 95 % CI were 1.20 （ 1.13,1.27 ） , 1.16 （ 1.03,1.30 ）, 1.21 （ 1.06,1.39 ）, 1.33 （ 1.22,1.46 ）, respectively. But there were no significant differences between CS group and S group in 1 - year survival rate, perioperative mortality. Conclusion： Compared with surgery alone for esophageal neoplasms, neoadjuvant chemotherap im- proves the radical resection rate, it＇s benefit to the patients in survival.