术后辅助化疗对新辅助放化疗后的进展期直肠癌患者预后影响的Meta分析

Postoperative adjuvant chemotherapy after neoadjuvant chemoradiation for advanced rectal carcinoma： a meta-analysis

目的 用Meta分析的方法,评价术后辅助化疗对行新辅助治疗直肠癌患者预后的影响.方法 检索PubMed已公开发表的有关新辅助治疗后术后辅助化疗对患者预后影响的所有临床研究,按纳入和排除标准筛选文献.并对符合条件的所有研究结果进行Meta分析,统计处理使用RevMan 5.0软件.结果 共纳入分析的文献总样本量为6212例;其中术后化疗组3421例,观察组2 791例.纳入各研究的平均年龄为55.6～68.0岁.最终分析结果提示,术后辅助化疗能改善接受新辅助放化疗患者的总体生存率（P =0.002）和无瘤生存率（P =0.000 5）.亚组分析显示ypT0-2分期患者和ypT3-4分期患者术后辅助化疗组与对照组的生存率差异无明显统计学意义,但由于亚组分析纳入的数据不全面,故可能存在偏倚.结论 术后辅助化疗能改善接受新辅助治疗的直肠癌患者的生存率,但对于新辅助治疗后达到病理完全缓解的患者难以进一步提高患者生存率,而对ypN＋分期的患者则可能效果不佳.

Objective To evaluate the impact of postoperative adjuvant chemotherapy on prognosis of patients with advanced rectal carcinoma using a meta-analysis.Methods We searched PubMed to identify literature comparing observation with adjuvant chemotherapy after neoadjuvant chemoradiotherapy and surgery for patients with advanced rectal carcinoma.Data were analysed using Revman 5.0 statistical software.Results Nine trials were included consisting of 6 212 patients：3 421 patients received adjuvant chemotherapy and 2 791 patients did not.The age ranged from 55.6 to 68 years.Adjuvant chemotherapysignificantly affects overall and disease-free survival （P =0.002 and P =0.000 5 respectively） of patientswho had received neoadjuvant chemoradiotherapy.The subgroup analysis which originate from insufficient data reveales ypT0-2 patients and ypT3-4 patients can＇t benefit from adjuvant chemotherapy.Conclusion Postoperative adjuvant chemotherapy can improve the survival of advanced rectal carcinoma patients after neoadjuvant chemoradiotherapy,but can＇t increase the survival of pathology complete respone and yPN ＋ patients.