含紫杉类新辅助化疗联合同期放化疗与同期放化疗单独治疗中晚期鼻咽癌的疗效的Meta分析

Comparison of taxane-containing induction and followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in advanced nasopharyngeal carcinoma:A meta analysis

目的:评价含紫杉类新辅助化疗联合同期放化疗(IC+CCRT)治疗中晚期鼻咽癌的疗效。方法:计算机检索pubmed、embase、cochrane图书馆、CNKI等数据库有关与含紫杉类新辅助化疗联合同期放化疗治疗中晚期鼻咽癌的随机对照试验,按研究设计标准由两位研究者独立进行筛选、提取相关资料并用Rev Man5.3软件进行统计分析。结果:9项RCT共786例患者纳入本研究,Meta分析显示,含紫杉类IC+CCRT与CCRT相比:2年总生存率,3年总生存率、3年PFS均无改善;治疗后结束近期鼻咽CR率。结论:含紫杉类新辅助化疗联合同期放化疗较同期放化疗单独治疗中晚期鼻咽癌能提高治疗后近期鼻咽肿瘤CR率[OR=1.08,95%CI=(1.02,1.15),P=0.01],但对治疗后近期转移颈部淋巴结CR率、2年、3年生存期及3年无病生存期均无影响。结论:含紫杉类新辅助化疗联合同期放化疗(IC+CCRT)并未改善中晚期鼻咽癌患者的生存率。

Objective：To evaluate the efficacy of taxane-containing induction and followed by concurrent chemoradiotherapy followed by concurrent chemoradiotherapy compared with concurrent chemoradiotherapy alone in the treatment of advanced nasopharyngeal carcinoma.Methods： The search strategy included Pubmed（1978-2016） , Embase（1978-2016）, theCochrane Library, China National Knowledge Internet Web （1978-2016） , Vipbrowser Database （1978-2016） and Wanfang Database （1978~2016）. We also searched reference lists of articles as a complement. RCTs that compared neoadjuvant chemotherapy followed by concurrent chemoradiotherapy （IC＋CCRT） with concurrent chemoradiotherapy （CCRT） alone in advanced nasopharyngeal carcinoma were included. After study selection, two reviewers assessed and extracted data independently. Meta-analysis was performed by using the RevMan5.3 software. Results： Nine studies were included in result of treatment evaluation; Three studies were included in 2 years and 3 years overall survival 3 years progression-free survival（PFS） evaluation： there had no significant difference between the two groups （P〉0.05）. Compared with CCRT, IC（of taxane-containing） ＋ CCRT got more response of primary lesions[OR= 1.08,95% CI = （1.02, 1.15）,P=0.01 ], but had no significant difference between the two groups in the CR of cervical lymph nodes （P〈0.05）. Conclusion： Even taxane-containing induction and followed by concurrent chemoradiotherapy didn＇t improve the survival of advanced nasopharyngeal carcinoma.