放化疗治疗Ⅱb～Ⅳa期局部晚期宫颈癌有效性与安全性的meta分析

Efficacy and safety of chemoradiotherapy for stages Ⅱb～Ⅳa locally advanced cervix cancer:a Meta-analysis

目的:系统评价放化疗与单纯放疗治疗Ⅱb～Ⅳa期局部晚期宫颈癌(LACC)的疗效与安全性。方法:计算机检索The Cochrane Library、Pub Med、Embase、Web of science、CBM、VIP、CNKI和Wan Fang Data数据库,检索时限为建库至2017年7月。筛选出符合纳入、排除标准的随机对照实验(RCT),提取资料数据及评价质量后,采用RevMan 5.3软件进行Meta分析。结果:共纳入15个RCT。Meta结果显示,放化疗组的完全反应率(OR=2.20,95%CI=1.66~2.92,P<0.00001)、5年无病生存率(OR=1.84,95%CI=1.39~2.42,P<0.0001)、3年生存率(OR=1.76,95%CI=1.43~2.16,P<0.00001)、5年生存率(OR=1.74,95%CI=1.37~2.21,P<0.00001)均明显高于单纯放疗组,差异有统计学意义。放化疗组的Ⅲ/Ⅳ级急性毒性反应发生率高于单纯放疗组,差异有统计学意义(OR=3.41,95%CI=2.29~5.09,P<0.00001);两组的Ⅲ/Ⅳ级迟发型毒性反应比较,差异无统计学意义(OR=1.36,95%CI=0.87~2.13,P=0.18)。结论:放化疗能显著提高LACC患者的近期和远期疗效,且能增加患者的Ⅲ/Ⅳ级急性毒性反应。但由于受纳入研究的质量及数量的限制,上述结论有待更多高质量研究予以证实。

Objective： To systematically review the efficacy and safety of chemoradiotherapy for LACC（ stage Ⅱb～Ⅳa）. Methods： We searched The Cochrane Library,Pub Med,Embase,Web of science,CBM,VIP,CNKI,and Wan Fang Data,from their established dates to July 2017.According to the inclusion and exclusion criteria,the eligible randomized controlled trials（ RCTs） were selected.After we extracted data and assessed the quality,Meta-analysis was performed by using Rev Man 5.3 sofware.Result： A total of 15 randomized controlled trials were included.The results of meta-analysis showed that,compared with the radiotherapy alone,chemoradiotherapy had significantly increased complete response rates（ OR = 2.20,95% CI = 1.66 -2.92,P 0. 00001）,5-year disease-free survival rates（ OR = 1. 84,95% CI = 1. 39 - 2.42,P 0.0001）,3-year survival rates（ OR = 1. 76,95% CI = 1. 43 - 2. 16,P 0.00001）,5-year survival rates（ OR = 1.74,95% CI = 1.37 - 2.21,P 0.00001）. However,chemoradiotherapy has a higher incidence of grade Ⅲ/Ⅳ acute toxicities（ OR = 3.41,95%CI = 2.29 - 5.09,P 0.00001）. Ⅲ/Ⅳ level late toxicities（ OR = 1.36,95%CI = 0.87 - 2.13,P = 0.18） in both groups were equivalent.Conclusion： Chemoradiotherapy improves long-term and short-term curative effects for patients with locally advanced cervix cancer,and has higher incidence of grade Ⅲ/Ⅳ acute toxicities.However,due to the limited quantity and quality of the included studies,more high quality studies with large sample size are still needed to verify the above conclusion.