紫杉醇联合卡铂化疗同步放疗治疗宫颈癌有效性与安全性的系统评价

Systematic Review of Effectiveness and Safety of Paclitaxel Combined with Carboplatin Synchronized with Radiotherapy and Chemotherapy in the Treatment of Cervical Cancer

目的:系统评价紫杉醇联合卡铂化疗同步放疗治疗宫颈癌的有效性与安全性。方法:计算机全面检索中英文数据库中有关紫杉醇联合卡铂化疗同步放疗治疗宫颈癌的随机对照试验(对照组患者采用单纯放疗,观察组患者采用紫杉醇联合卡铂化疗同步放疗),检索时限为各数据库建库起至2019年6月。根据Cochrane协作网质量评价标准提取资料,评定纳入研究的方法学质量,采用Rev Man 5. 3软件对结局指标进行荟萃分析(Meta分析)。结果:最终纳入17篇文献,合计1 609例患者。Meta分析结果显示,观察组患者近期疗效和远期疗效明显高于对照组,差异均有统计学意义(P<0. 05);两组患者不良反应发生情况的差异无统计学意义(P>0. 05)。此外,观察组患者宫颈癌肿瘤标志物鳞状上皮细胞癌抗原(SCCAg)和细胞角蛋白19片段抗原(CYFRA21-1)水平明显低于对照组,差异均有统计学意义(P<0. 05)。倒漏斗图左右不对称,提示纳入评价的文献存在一定的发表偏倚。结论:紫杉醇联合卡铂化疗同步放疗治疗宫颈癌的临床疗效显著优于单纯放疗,可提高疾病控制率、改善患者生活质量,并能减少胃肠道反应、骨髓抑制、放射性结肠炎和放射性膀胱炎等不良反应。由于本研究所纳入的随机对照试验方法学质量较低,尚需开展更多设计合理、大样本、多中心的随机对照试验以验证其临床有效性及安全性,从而为紫杉醇联合卡铂化疗同步放疗在临床上治疗宫颈癌提供安全、有效的指导。

OBJECTIVE: To systematically evaluate the efficacy and safety of paclitaxel combined with carboplatin synchronized with radiotherapy and chemotherapy in the treatment of cervical cancer. METHODS: Chinese and English database were retrieved to collect the randomized controlled trial of paclitaxel combined with carboplatin synchronized with radiotherapy and chemotherapy in the treatment of cervical cancer( the control group was treated with radiotherapy alone,while the observation group received paclitaxel combined with carboplatin synchronized with radiotherapy and chemotherapy). The retrieve time was from the establishment of the database to Jun. 2019. Data were extracted according to the Cochrane Collaboration Network Quality Evaluation Standards,the methodological quality of the included literature was assessed,and RevMan 5. 3 software was used to conduct on the outcome indicators( Meta analysis). RESULTS: Totally 17 literature were collected,including 1 609 patients. The results of meta-analysis showed that the short-term and long-term efficacy of the observation group was significantly higher than that of the control group,with statistically significant differences( P<0. 05). There was no significant difference in the incidence of adverse drug reactions between two groups( P > 0. 05). Cervical cancer detection markers such as squamous epithelial cell carcinoma antigen( SCCAg) and cytokeratin 19 fragment antigen( CYFRA21-1) in the observation group were significantly lower than those in the control group,and the differences were statistically significant( P <0. 05). The asymmetry between left and right funnel diagrams suggested that there was a certain publication bias in the included lioteratyre. CONCLUSIONS: The clinical efficacy of paclitaxel combined with carboplatin synchronized with radiotherapy and chemotherapy in the treatment of cervical cancer is significantly better than that of radiotherapy alone,which can improve the disease control rate,improve the quality of life of patients,and reduce gastrointestinal reactions,bone marrow suppression,radiation colitis,radiation cystitis and other adverse drug reactions. Due to the low quality of the randomized controlled trials included in this study,more rationally designed,large-sample,multicenter randomized controlled trials need to be carried out to verify its clinical effectiveness and safety,so as to provide safe and effective guidance for paclitaxel combined with carboplatin synchronized with radiotherapy and chemotherapy in the treatment of cervical cancer.