术后放疗与术后化疗辅助治疗子宫内膜癌的Meta 分析

Postoperative radiotherapy and postoperative chemotherapy for patients with endometrial cancer：a Meta-analysis

目的：全面评价术后放疗与术后化疗辅助治疗子宫内膜癌的有效性和安全性，为临床合理选择提供决策依据。方法计算机检索 EMBase、PubMed、Cochrane Library、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、维普中文科技期刊全文数据库（VIP），检索截止时间为2015年8月31日。全面收集术后放疗与术后化疗辅助治疗子宫内膜癌的随机对照试验（RCT），两名评价者独立评价纳入文献的方法学质量并交叉核对提取资料，采用 RevMan 5．1软件进行统计分析。结果最终纳入3篇 RCT（1121例子宫内膜癌患者），Meta 分析结果显示，与术后化疗辅助治疗相比，术后放疗并不能提高子宫内膜癌5年生存率（RR ＝0．94，95％CI 为0．80～1．10，Z ＝0．77，P ＝0．440）、5年无疾病进展生存率（RR ＝0．98，95％CI 为0．90～1．07，Z ＝0．52，P ＝0．610）和降低复发率（RR ＝1．06，95％CI 为0．91～1．24，Z ＝0．75，P ＝0．450），但可降低3～4级血小板减少症（RR ＝0．13，95％CI 为0．07～0．27， Z ＝5．62，P ＜0．00001）和3～4级中性粒细胞减少症（RR ＝0．01，95％CI 为0．00～0．03，Z ＝8．27，P ＜0．00001），差异有统计学意义。对于Ⅲ～Ⅳ期子宫内膜癌患者而言，与术后放疗相比，术后化疗辅助治疗可以提高晚期子宫内膜癌的5年生存率（RR ＝0．79，95％CI 为0．68～0．91，Z ＝3．15，P ＝0．002）和5年无疾病进展生存率（RR ＝0．82，95％CI 为0．69～0．97，Z ＝2．31，P ＝0．020），且差异有统计学意义。结论当前证据表明，与术后放疗相比，术后化疗可能会提高晚期患者的生存率，其远期疗效尚待大样本高质量的 RCT 进一步证实。

Objective To systematically review the efficacy and safety of postoperative radiotherapy and postoperative chemotherapy for patients with endometrial cancer,which may give support for clinical proper selection.Methods The randomized controlled trials （RCTs）comparing postoperative radiotherapy with post-operative chemotherapy for patients with endometrial cancer were searched in EMBase,PubMed,Cochrane Library,Chinese Biomedical Literature Data,China National Knowledge Infrastructure,and VIP database from the inception to August 201 5.Two reviewers independently assessed the quality of included studies and extrac-ted data.We analyzed the statistic data using RevMan 5.1 software.Results Three RCTs concluding 1 1 21 patients were included.Meta analysis showed that there were no significant differences between the two groups in five-year survival rate （RR =0.94,95%CI：0.80-1 .1 0,Z =0.77,P =0.440）,five-year progression-free survival rate （RR =0.98,95%CI：0.90-1 .07,Z =0.52,P =0.61 0）and recurrence rate （RR =1 .06, 95%CI：0.91 -1 .24,Z =0.75,P =0.450）,but there were significant differences between the two groups in grade 3-4 thrombocytopenia （RR =0.1 3,95%CI：0.07-0.27,Z =5.62,P 〈0.000 01 ）and grade 3-4 neu-tropenia （RR =0.01 ,95%CI：0.00-0.03,Z =8.27,P 〈0.000 01 ）.Subgroup analysis showed that there were significant differences between the two groups in five-year survival rate （RR =0.79,95%CI：0.68-0.91 , Z =3.1 5,P =0.002）and five-year progression-free survival rate （RR =0.82,95%CI：0.69-0.97,Z =2.31 ,P =0.020）for patients with Ⅲ-Ⅳ stage endometrial cancer.Conclusion Current evidence indicates that compared with postoperative radiotherapy,postoperative chemotherapy may improve the survival rate for pa-tients with advanced stage endometrial cancer.The long-term curative effects still need to be confirmed by RCTs with high quality and large sample.