紫杉类-顺铂-氟尿嘧啶联合诱导化疗对晚期头颈癌疗效和安全性的Meta分析

Taxane-cisplatin-fluorouracil as induction chemotherapy for advanced head and neck cancer:a Meta-analysis of the efficacy and safety

目的:系统评价紫杉类-顺铂-氟尿嘧啶联合诱导化疗治疗晚期头颈癌的疗效和安全性。方法:计算机检索PubMed、Embase、SpringerLink、MEDLINE和the Cochrane Library数据库,检索时限从建库至2015年2月,纳入有关紫杉类-顺铂-氟尿嘧啶联合诱导化疗治疗晚期头颈癌的文献。由2名评价员按照纳入与排除标准独立筛选文献、提取资料和评价质量后,使用Stata 13.0软件进行Meta分析。结果:共纳入7个RCT,2 702例患者,Meta分析结果显示:与顺铂-氟尿嘧啶组对比,紫杉类-顺铂-氟尿嘧啶组的3年生存率[HR=1.14,95%CI(1.03,1.25),P<0.01]、3年无进展生存率[HR=1.24,95%CI(1.08,1.43),P<0.01]、5年生存率[HR=1.30,95%CI(1.09,1.55),P<0.01]、5年无进展生存率[HR=1.39,95%CI(1.14,1.70),P<0.01]和总有效率[OR=1.66,95%CI(1.35,2.05),P<0.01]均明显优于顺铂-氟尿嘧啶组。对于毒副作用,中性粒细胞减少性发热[OR=2.36,95%CI(1.62,3.46),P<0.01]、脱发[OR=8.22,95%CI(3.99,16,92),P<0.01]、腹泻[OR=1.57,95%CI(1.05,2.36),P<0.05]和白细胞减少症[OR=2.79,95%CI(1.86,4.21),P<0.01]的发生率高于顺铂-氟尿嘧啶组。结论:相对于顺铂-氟尿嘧啶组,紫杉类-顺铂-氟尿嘧啶联合诱导化疗提高了晚期头颈癌的无进展生存期、生存率和总有效率,但有着更高的不良事件发生率。

Objective： To systematically review the efficacy and safety of taxane, cisplatin, and fluorouracil （Tax-PF） as induction chemotherapy for advanced head and neck cancer. Method：Literature about the efficacy and safety of Taxane-cisplatin-fluorouracil as induction chemotherapy for advanced head and neck cancer was retrieved from digital databases of PubMed, Embase, SpringerLink, MEDLINE and the Cochrane Library before February 2015. Data extraction and quality assessment of included studies were conducted by two reviewers independently. Stata 13.0 was then used to perform Meta-analysis. Result： A total 7 randomized controlled trials involving 2 702 were included. The 3-year OS rate [HR=1. 14, 95%CI （1.03, 1.25）, P〈0.01], 3-year PFS rate [HR=1. 24, 95%CI （1.08, 1.43）, P〈0.01], 5-year OS rate [-HR=1. 30, 95%CI （1.09, 1.55）, P〈0.01], 5-year PFS rate [HR= 1.39, 95 % cI （1.14, 1.70）, P〈0. 01] and ORR to chemotherapy [OR = 1.66, 95 M CI （1. 35, 2.05）, P〈0.01] of the patients in the Tax-PF group were statistically superior to those in the PF group. In terms of toxicities, the incidence of febrile neutropenia [OR=2.36, 95%CI （1.62, 3.46）, P〈0.01], alopecia [OR=8.22, 95%CI （3.99, 16.92）, P〈0.01], diarrhea[OR=1.57, 95%CI （1.05, 2.36）, P〈0.05] and leu- copenia [OR=2.79, 95%CI （1.86, 4.21）, P〈0.01] was higher in the Tax-PF group than that in the PF group. Conclusion：The Tax-PF induction chemotherapy improved PFS and OS, and the ORR was better as compared to PF-based therapy regimens at the cost of a higher incidence of adverse events.