中医药联合同步放化疗对鼻咽癌疗效影响的Meta分析

Meta Analysis of the Effect of Traditional Chinese Medicine Combined with Concurrent Chemoradiotherapy on Nasopharyngeal Carcinoma

目的系统评价中医药联合同步放化疗治疗鼻咽癌的疗效是否优于单纯放化疗治疗。方法计算机检索MEDLINE、EMbase、SCI、CBM、CNKI、VIP、Pub Med等数据库,收集中医药联合放化疗治疗(实验组)与单纯放化疗治疗鼻咽癌患者(对照组)疗效影响的随机对照试验(RCT)。由2位评价者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Rev Man5.1软件进行Meta分析。结果我们最终纳入37篇文献,其中包括2023例实验组和1852例对照组。Meta分析显示:中医药联合放化疗同步治疗能够改善鼻咽癌患者预后。其中预后>=1年组(RR=0.48,95%CI=0.38-0.61,16例临床研究,实验组/对照组=794/761),预后>=3年组(RR=0.78,95%CI=0.65-0.94,15例临床研究,实验组/对照组=819/684),预后>=5年组(RR=0.84,95%CI=0.76-0.93,10例临床研究,实验组/对照组=756/673),差异有统计学意义。同时还发现,实验组的肿瘤具有更好的整体效应速度(整体反应率比=1.07,95%CI=1.01-1.14),其中有20个研究,实验组/对照组=914/837)。结论不论在短期还是长期疗效上,中医药联合同步放化疗治疗鼻咽癌的疗效都优于单纯放化疗治疗。受纳入文献的方法学质量和样本量限制,上述结论尚待更多高质量的RCT加以验证。

Objective： To comprehensively assess the curative effect of Chinese medicine combined with concurrent chemoradiotherapy on nasopharyngeal carcinoma to see whether the effect of combined method is superior to the simple chemoradiotherapy. Method： Retrieved from MEDLINE, Embase, SCI, CBM, CNKI, VIP and PubMed database, the materials were collectecl to get a conclusion for randomized controlled trials （RCTs） of the effect comparisons between the combining method （the experimental group） and the simple chemoradiotherapy （the control group） in treating nasopha- ryngeal carcinoma. The Meta analysis was conducted by two reviewers with RevManS. 1 software who independently screened the literature, extracted data and evaluated risk of bias containing in the collected data. Results： Totally 37 arti- cles were brought into the research, containing 2023 cases of experimental group and 1852 cases of control group. Resultsof Meta analysis indicated that Chinese medicine combined with radiotherapy and chemotherapy can improve the prognosis of patients with nasopharyngeal carcinoma. The prognosis more than 1 year： RR--0.48, 95% CI = 0.38 -0.61, 16 ca- ses of clinical research, experimental group / control group = 794/761 ; the prognosis more than 3 years ： RR = 0. 78, 95% CI = 0.65 - 0.94, 15 cases of clinical research, experimental group / control group = 819/684 ; the prognosis more than 5 years： RR =0.84, 95% CI =0.76-0.93, 10 cases of clinical research, experimental group/control group = 756/673; all the difference showed statistical meaning. Meanwhile, it was showed that the tumor in the experimental group had a better overall effective rate （ total reactive rate = 1.07, 95% CI = 1.01 - 1.14, 20 cases of clinical research, experimental group/control group = 914/837）. Discussion： Whether in the short term or long term, curative effect of TCM combined with radiotherapy and chemotherapy in the treatment of nasopharyngeal carcinoma was better than chemo- therapy. Limited by the methodological quality and sample＇ s quantity in the collected literature, the achieved conclusion still needs to be verified with more high - qualified RCT.