直肠癌术前短疗程放疗立即手术与长疗程放化疗推迟手术的Meta分析

Short-course preoperative radiotherapy with immediate surgery versus long-course chemoradiotherapy with delayed surgery in treatment of rectal cancer: a meta-analysis

目的直肠癌术前短疗程放疗(SCRT)立即手术与长疗程放化疗(LCRT)推迟手术均是当前直肠癌治疗非常重要的手段,通过Meta分析比较这两种方案的疗效及不良反应。方法计算机检索CochraneLibrary、PubMed、Embase、中国知网、万方数据库,收集直肠癌术前短疗程放疗立即手术与长疗程放化疗推迟手术相关研究的文献,采用RevMan5.3软件进行Meta分析。结果最终纳入研究共10项,其中包括5个随机对照试验。Meta分析结果显示LCRT组在R0切除率、T分期降期率及病理完全反应率明显高于SCRT组;同时也增加了早期不良反应发生率;两方案保肛率、局部复发率、远处转移率、无瘤生存率、总生存率、晚期严重不良反应发生率及术后并发症均相近(P均>0.05)。结论直肠癌术前长疗程放化疗推迟手术较术前短疗程放疗立即手术提高了T分期降期、R0切除率及病理完全反应率,但同时也增加了急性不良反应,而对总体的术后并发症无明显影响。

Objective At present, short-course radiotherapy (SCRT) with immediate surgery and long-course chemoradiotherapy (LCRT) with delayed surgery are extremely important regimens in the treatment of rectal cancer. In this meta-analysis, the clinical efficacy and safety were statistically compared between two regimes. Methods Literatures related to SCRT and LCRT including randomized controlled studies and clinical studies were searched from Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure (CNKI) and Wanfang database with regard to SCRT with immediate surgery or LCRT with delayed surgery. Meta-analysis was conducted by using RevMan 5.3 software. Results Ten studies were finally selected including 5 randomized controlled trials. Meta-analysis demonstrated that the RO resection rate, T downstaging rate, pathological complete response (pCR) rate in the LCRT group were significantly higher than those in the SCRT group. The incidence rate of adverse events in the LCRT group was higher compared with that in the SCRT group. The sphincter-preservation rate, local recurrence rate, distant metastasis rate, disease-free survival rate, overall survival, late toxicity and postoperative complications did not significantly differ between two groups (all P>0.05). Conclusions Compared with SCRT, LCRT can increase the T downstaging rate, R0 resection rate and pCR rate, whereas elevate the incidence rate of acute adverse events. LCRT exerts no significant effect upon overall postoperative complications.