多西他赛联合三维适形放疗治疗食管癌有效性和安全性的系统评价

Efficacy and safety of docetaxel chemotherapy combine with 3-dimensional conformal radiation therapy in treatment of esophageal cancer:a systematic review

目的系统评价多西他赛联合三维适形放疗(3D-CRT)治疗食管癌的有效性和安全性。方法计算机检索Pub Med、EMbase、The Cochrane Library、Web of Science、CNKI和Wan Fang Data数据库,搜集关于多西他赛联合3D-CRT治疗食管癌的随机对照试验(RCT)和半随机对照试验(q RCT),检索时限均为建库至2017年2月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析。结果共纳入17个RCT,包括1 353例患者。Meta分析结果显示:与单纯放疗相比,多西他赛联合3D-CRT可提高治疗食管癌的有效率[OR=1.25,95%CI(1.07,1.47),P=0.003]、3年总生存率[OR=1.91,95%CI(1.19,3.06),P=0.006],但在1年总生存率[OR=1.28,95%CI(0.95,1.72),P=0.105]、骨髓抑制发生率[OR=1.13,95%CI(0.85,1.49),P=0.389]和消化道反应发生率[OR=1.19,95%CI(0.90,1.57),P=0.181]方面,两组差异无统计学意义。结论与单纯放疗相比,多西他赛联合3D-CRT能提高食管癌患者治疗的有效率和3年总生存率,未增加治疗后不良反应发生率。受纳入研究的数量和质量限制,上述结论仍需开展更多高质量研究予以验证。

Objective To systematically review efficacy and safety of docetaxel chemotherapy combine with 3- dimensional conformal radiation therapy （3D-CRT） in treatment of esophageal cancer. Methods Databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI and WanFang Data were searched from inception to February 2017 to collect randomized controlled trials （RCTs） and quasi-randomized control trials （qRCTs） about docetaxel chemotherapy combine with 3D-CRT in treatment of esophageal cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using Stata 12.0 software. Results A total of 17 RCTs involving 1 353 patients were included. The results of meta-analysis showed that, compared with the radiotherapy alone, the docetaxel chemotherapy combine with 3D-CRT could improve effective rate （OR=1.25, 95%CI 1.07 to 1.47, P=0.003）, 3-year survival rate （OR=1.91, 95%CI 1.19 to 3.06, P=0.006）, but there were no significant differences in 1-year survival rate （OR=1.28, 95%CI 0.95 to 1.72, P=0.105）, hematologic toxicities （OR=1.13, 95%CI 0.85 to 1.49, P=0.389） and gastrointestinal reactions （OR=1.19, 95%CI 0.90 to 1.57, P=0.181）. Conclusions Compared with radiotherapy alone, docetaxel chemotherapy combine with 3D-CRT can improve the effective rate, 3-year survival rate, but not increase the incidences of adverse effects. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify above conclusion.