同期放化疗与同期放化疗后手术治疗中晚期宫颈癌疗效的Meta分析

A Meta-analysis of the efficacy of concurrent chemoradiation with or without subsequent radical surgery for patients with advanced cervical cancer

目的系统评价同期放化疗后再行根治性手术与仅行同期放化疗治疗中晚期宫颈癌的临床疗效。方法检索PubMed、Medline、the Cochrane Library、中国知网、维普等数据库,筛选关于同期放化疗后再行根治性手术和仅行同期放化疗的符合纳入标准的文献,评价纳入文献的方法学质量,提取资料,应用Review Manager 5.3软件进行Meta分析。结果纳入8篇文献,其中6篇为病例对照研究,2篇为随机对照试验,包括1286例患者,其中718 例患者接受了同期放化疗+全子宫双附件联合全盆腔淋巴结扫除术治疗(CCRT+S 组),568 例患者仅接受了同期放化疗治疗(CCRT 组)。Meta 分析结果显示,CCRT+S 组患者的3 年总生存率(OR=1.60,95%CI:1.20~2.14,P﹤0.01)、3 年无进展生存率(OR=1.89,95%CI:1.41~2.55,P﹤0.01)、5 年总生存率(OR=1.91,95%CI:1.36~2.69,P﹤0.01)、5 年无进展生存率(OR=2.27,95%CI:1.62~3.17,P﹤0.01)均高于CCRT 组,复发率低于CCRT 组(OR=0.51,95%CI:0.37~0.70,P﹤0.01)。两组患者的盆腔复发率比较,差异无统计学意义(OR=0.54,95%CI:0.21~1.38,P﹥0.05)。结论同期放化疗后再行根治性手术可以提高中晚期宫颈癌患者的3年总生存率、3年无进展生存率、5 年总生存率、5 年无进展生存率,并可降低复发率,但对盆腔复发率无明显影响。

Objective To systematically investigate the clinical efficacy of concurrent chemoradiotherapy followed by surgery and concurrent chemoradiotherapy alone in the treatment of advanced cervical cancer. Method A database retrieval was performed in PubMed, Medline, Cochrane Library, CNKI and VIP, to screen the literature focusing on concurrent chemoradiotherapy+subsequent radical resection or concurrent chemoradiotherapy alone for advanced cervical cancer, and then the quality of methodology was assessed and data were extracted and analyzed using RevMan 5.3 software. Result Eight literatures were included, 6 of which were case-control studies and 2 were randomized controlled trials, comprising 1286 patients, among whom 718 patients received concurrent chemoradiotherapy combined with total hysterectomy with bilateral salpingo-oophorectomy and en bloc pelvic lymph node dissection (CCRT+S group), and another 568 patients received concurrent chemoradiotherapy only (CCRT group). According to the Meta-analysis results, the 3- year overall survival rate (OR=1.60, 95%CI: 1.20-2.14, P<0.01), 3-year progression-free survival rate (OR=1.89, 95%CI: 1.41-2.55, P<0.01), 5-year overall survival rate (OR=1.91, 95%CI: 1.36-2.69, P<0.01), and 5-year progression-free survival rate (OR=2.27, 95%CI: 1.62-3.17, P<0.01) of patients in the CCRT+S group were all higher than those in the CCRT group, and the recurrence rate (OR=0.51, 95%CI: 0.37-0.70, P<0.01) was lower instead, with statistically significant differences observed. There was no statistically significant difference in the pelvic recurrence rate between the two groups (OR=0.54, 95%CI: 0.21- 1.38, P>0.05). Conclusion The outcome of this Meta- analysis is in favor of the therapy of CCRT followed by radical surgery, which may improve the 3-year overall survival, 3-year progression-free survival, 5- year overall survival, and 5- year progression- free survival, besides, the regimen might help reduce the recurrence rate while imposes little impact on the pelvic recurrence rate.