西妥昔单抗联合放化疗治疗食管癌的Meta分析

A Meta- analysis of cetuximab combined with chemoradiotherapy in patients with esophageal cancer

目的:系统评价西妥昔单抗联合放化疗与单纯放化疗相比,治疗食管癌患者的疗效及安全性。方法:检索Pub Med,Web of Science,Embase,ASCO等会议摘要内容,The New England Oncology杂志,The Lancet Oncology杂志及JCO杂志等,搜索截止至2015年10月。按纳入及排除标准筛选文献,应用Rev Man 5.3(Copenhagen:The Nordic Cochrane Centre,The Cochrane Collaboration,2013)软件对数据进行Meta分析。结果:共纳入5项RCTs,包含823例食管癌患者。Meta分析显示,西妥昔单抗联合放化疗与单纯放化疗相比,对食管癌患者ORR[RR=1.08,95%CI(0.88,1.33),P>0.05]、OS[HR=1.02,95%CI(0.77,1.37),P>0.05]的改善无显著统计学差异。亚组分析结果显示:不论是食管鳞癌或是腺癌,两组对OS的改善无显著统计学差异[HR=0.92,95%CI(0.76,1.11),P>0.05]。并发症中皮疹[RR=16.46,95%CI(3.22,84.07),P<0.05]的发生率有显著统计学差异。结论:在基因突变不明的情况下,西妥昔单抗联合放化疗与单纯放化疗相比,无论治疗食管腺癌或是鳞癌,均未能明显提高患者的有效率和总生存期,且增加皮疹III级不良反应的发生率。

Objective：To use Meta -analysis to evaluate the clinical efficacy and safety of cetuximab for esopha-geal cancer.Methods：Relevant literatures were searched through PubMed,Web of Science,Embase,abstract from the meeting of ASCO,The New England Oncology,The Lancet Oncology and JCO.Results：Five randomized controlled tri-als were included with a total of 823 patients with esophageal cancer.Meta -analysis suggested that cetuximab com-bined with chemoradiotherapy couldn＇t improve the objective effective rate[RR =1.08,95%CI（0.88,1.33）,P〉0.05]and OS[HR =1.02,95%CI（0.77,1.37）,P〉0.05],compared with the control group.Subgroup analysis showed that there was no differrence between these two groups for OS[HR =0.92,95%CI（0.76,1.11）,P〉0.05]. And the higher incidence of rash[RR =16.46,95%CI（3.22,84.07）,P〈0.05]was found.Conclusion：Cetuximab combined with chemoradiotherapy didn＆#39;t improve the effective rate and overall survival rate for patients of adenocarci-noma and squamous esophageal cancer,and increased the incidence of rash,when the gene mutation condition is un-known.