辅助化疗对直肠癌患者预后影响的Meta分析

The Postoperative Outcome of Adjuvant Chemotherapy for Patients with Rectal Cancer: A Meta-Analysis

目的 系统评价辅助化疗对直肠癌患者预后的影响。方法 计算机检索Pub Med、Cochrane Library、EMBAS、中国生物医学文献数据库、中国学术期刊全文数据库、数字化期刊全文数据库、维普中文科技期刊数据库等数据库中的、关于直肠癌患者于直肠癌根治术后行辅助化疗与单纯行直肠癌根治术预后比较的随机对照试验,采用Rev Man 5.2软件进行Meta分析。结果 最终纳入8篇文献,共3 654例直肠癌患者。Meta分析结果表明：1对所有直肠癌患者而言,辅助化疗组的2（OR=1.28,95%CI：1.05～1.57,P=0.020）、3（OR=1.28,95%CI：1.09～1.51,P=0.003）及5年（OR=1.21,95%CI：1.05～1.40,P=0.008）生存率均高于单纯手术组,而5年复发率低于单纯手术组（OR=0.61,95%CI：0.52～0.72,P〈0.000 01）;2对Ⅱ期直肠癌患者而言,与单纯手术组比较,辅助化疗组的5年生存率较高（OR=1.39,95%CI：1.09～1.78,P=0.009）,5年复发率较低（OR=0.65,95%CI：0.49～0.87,P=0.003）;3对于Ⅲ期直肠癌患者而言,辅助化疗组的5年复发率较低（OR=0.40,95%CI：0.26～0.64,P=0.000 1）,但其5年生存率与单纯手术组的差异不明显（OR=1.27,95%CI：1.00～1.61,P=0.050）。结论 与单纯手术相比,直肠癌根治术后行辅助化疗可改善直肠癌患者的术后生存情况,并减少其肿瘤复发。

Objective To assess the effect of adjuvant chemotherapy for patients with rectal cancer. Methods The related randomized controlled trials comparing patients underwent radical surgery for rectal cancer with（adjuvant chemotherapy group） or without（surgery alone group） adjuvant chemotherapy, were retrieved from the databases such as Pub Med, Cochrane Library, EMBAS, CBM, CNKI, Wan Fang, and VIP, then using Rev Man 5.2 software to conduct the Meta-analysis. Results A total of 8 articles involving 3 654 patients were included. The results of Meta-analysis showed that： 1 for all patients with rectal cancer, the 2-（OR=1.28, 95% CI： 1.05-1.57, P=0.020）, 3-（OR=1.28, 95% CI： 1.09-1.51, P=0.003）, and 5-year（OR=1.21. 95% CI： 1.05-1.40, P=0.008） survival rates of adjuvant chemotherapy group were higher than those of surgery alone group, respectively. 2 For patients with rectal cancer of Ⅱ staging, compared with surgery alone group, the 5-year survival rate was higher in adjuvant chemotherapy group（OR=1.39, 95% CI： 1.09-1.78, P=0.009）, but 5-year recurrence rate was lower in adjuvant chemotherapy group（OR=0.65, 95% CI： 0.49-0.87, P=0.003）. 3 For patients with rectal cancer of Ⅲ staging, compared with surgery alone group, the 5-year recurrence rate was lower in adjuvant chemotherapy group（OR=0.40, 95% CI： 0.26-0.64, P=0.000 1）, but there was no significant difference on the 5-year survival rate（OR=1.27, 95% CI： 1.00-1.61, P=0.050）. Conclusion Compared with radical surgery, radical surgery combined with postoperative adjuvant chemotherapy can improve the survival and reduce the recurrence for patients with rectal cancer.