Ⅱ期结直肠癌术后化疗临床预后危险因素的Meta分析

A Meta-Analysis of Association between Postoperative Adjuvant Chemotherapy and Clinical Prognosis with Risk Factors for StageⅡ Colorectal Cancer

目的系统评价Ⅱ期结直肠癌根治性手术后化疗与临床预后和相关危险因素之间的关联。方法通过检索数据库,纳入从2007 年3 月至2018 年3 月所有符合纳入标准的、有关Ⅱ期结直肠癌根治性术后化疗的研究,用RevMan 5.3 软件进行森林图分析,探讨术后化疗及化疗方案对总生存率和无复发生存率的影响,并详细分析伴有相关危险因素患者术后化疗与预后的关联。结果共20 篇文献纳入研究,累计289 684 例患者。Meta 分析合并结果显示,Ⅱ期结直肠癌患者根治性术后常规化疗,对总生存率无明显提高(比值比=0.98,95%可信区间0.84-1.16,P=0.85),对无复发生存率无明显提高(比值比=0.85,95%可信区间0.69-1.05,P=0.13)。相关危险因素的分析,将T4 期、低分化或未分化、伴肠梗阻或肠穿孔、伴淋巴/血管或周围神经浸润、伴不充足淋巴结检出数的患者纳入研究,结果提示伴有相关危险因素的患者,术后化疗均可显著提高临床疗效(P<0.05)。以5-氟尿嘧啶为主的术后常规化疗方案中,奥沙利铂的加入对总生存率无显著提高(比值比=0.99,95%可信区间0.80-1.22,P=0.92),但对无复发生存率有显著提高(比值比=0.81,95%可信区间0.68-0.96,P=0.02)。结论Ⅱ期结直肠癌患者根治性术后,若无相关危险因素,无需常规化疗。伴有相关危险因素的Ⅱ期结直肠癌患者,建议术后化疗。奥沙利铂+5-氟尿嘧啶+亚叶酸钙(FOLFOX)化疗方案,虽然无法提高总生存率,但是可以显著提高无复发生存率,控制术后复发。

Objective The purpose of this study is to evaluate the association of postoperative adjuvant chemotherapy and clinical prognosis,as well as the relative risk factors. Method Case-control studies assessing the postoperative adjuvant chemotherapy and clinical prognosis or relative risk factors for stage Ⅱ colorectal cancer were searched from databases between March 2007 and March 2018. Overall survival(OS),recurrence-free survival(RFS) were calculated and systematically analyzed by forest plot in RevMan 5.3. Result 20 case-control studies which covered a total of 289 684 patients were contained in this meta - analysis. The result of this study indicated that regular postoperative adjuvant chemotherapy for stage Ⅱ colorectal cancer would not improve OS(OR=0.98,95%CI 0.84-1.16, P=0.85)or RFS(OR=0.85,95%CI 0.69-1.05,P=0.13). However,when relative risk factors taken into consideration, such as T4 stage,poor differentiation or undifferentiation,intestinal obstruction or perforation,lymph or vascular or peripheral nerve invasion,inadequate sampled lymph nodes,patients would significantly benefit from postoperative adjuvant chemotherapy as a whole(P<0.05). For the chemotherapy regime ,adding of Oxaliplatin into conventional 5-Fluorouracil would not affect the OS(OR=0.99,95%CI 0.80-1.22,P=0.92),but do improve RFS(OR=0.81,95% CI 0.68-0.96,P=0.02),which significantly decrease the postoperative recurrence. Conclusion For stage Ⅱ colorectal cancer patients,after curative operation,chemotherapy does not need to apply routinely,but need to use in those with risk factors. Although Oxaliplatin+5-Fluorouracil+Leucovorin(FOLFOX)does not significantly improve OS,the better RFS suggests a better control of postoperative recurrence.