多西他赛、顺铂、5-氟尿嘧啶治疗晚期食管癌的meta分析

Meta-analysis of docetaxel,cisplatin and 5-fluorouracil in treatment of advanced esophageal cancer

目的探讨多西他赛、顺铂、5-氟尿嘧啶治疗晚期食管癌的安全性和有效性。方法检索PubMed、Cochrane Library、Wed of science、Embase、中国生物医学文献服务系统、万方数据库及中国知网(CNKI)数据库,搜集从建库至2019年12月晚期食管癌患者中应用多西他赛、顺铂、5-氟尿嘧啶的多中心随机对照试验(mcRCTs)。结果共检索到符合纳入标准的文献4篇(n=764),纳入文献偏倚风险较小。多西他赛联合顺铂联合5-氟尿嘧啶组(DCF)组的客观有效率(ORR)、总生存期(OS)与对照组相比差异有统计学意义(P=0.93,I 2=0<50%,RR=1.58,95%CI 1.28-1.94,P<0.01;P=0.86,I 2=0<50%,HR=1.16,95%CI 1.05~1.29,P=0.003),但在疾病控制率(DCR)方面差异无统计学意义(OR=1.23,95%CI 0.74-2.05,P=0.42)。不良反应方面DCF组在血小板减少[1~4级:OR=2.15(1.04-4.46),P=0.04;3~4级:OR=9.64(9.19-78.08),P=0.03]、腹泻[1~4级:OR=2.06(1.27-3.33),P=0.003,3~4级:OR=3.01(1.87-4.83),P<0.01]、黏膜炎[1~4级:OR=4.21(2.56-6.92),P<0.01,3~4级:OR=3.65(1.22-10.90),P=0.02]的发生高于对照组,在白细胞减少、贫血、恶心、呕吐方面两组差异无统计学意义(P>0.05)。结论多西他赛、顺铂、5-氟尿嘧啶三药联合治疗晚期食管癌未见明显疗效,同时增大血小板减少、腹泻、黏膜炎不良反应,临床上要慎用于治疗晚期食管癌。

Objective To systematically review efficacy and safety of docetaxel,cisplatin and 5-fluorouracil in treatment of advanced esophageal cancer.Methods PubMed,Cochrane Library,Web of Science,Excerpta Medica Database(EMbase),Chemical-Biological Munitions(CBM),WanFang Data and Chinese National Knowledge Infrastructure(CNKI)were searched for the multi-center randomized controlled trials(mcRCTs)about docetaxel,cisplatin and 5-fluorouracil in treatment of advanced esophageal cancer from inception to December 2019.Results A total of 4 mcRCTs involving 764 patients were included.The studies were of low bias according to the bias assessment tools.There were significant differences in ORR and OS between DCF group(in which esophageal cancer patients treated with docetaxel combine with cisplatin and 5-fluorouracil)and control group(P=0.93,I 2=0<50%,RR=1.58,95%CI[1.28-1.94],P<0.01;P=0.86.I 2=0<50%,HR=1.16,95%CI 1.05-1.29,P=0.003).But,there were no significant differences in DCR(OR=1.23,95%CI 0.74-2.05,P=0.42).In terms of adverse events,the incidence rates of thrombocytopenia(Level:1-4,OR=2.15,95%CI[1.04-4.46],P=0.04;Level:3-4,OR=9.64,95%CI[9.19-78.08],P=0.03),diarrhea(Level:1-4,OR=2.06,95%CI[1.27-3.33],P=0.003;Level:3-4,OR=3.01,95%CI[1.87-4.83],P<0.01),mucositis(Level:1-4,OR=4.21,95%CI[2.56-6.92],P<0.01;Level:3-4,OR=3.65,95%CI[1.22-10.90],P=0.02)in DCF group were higher than those in control group.There were no significant differences in leukocytopenia,anaemia,nausea and vomit between those two groups(P>0.05).Conclusion Docetaxel combine with cisplatin and 5-fluorouracil showed no significant effects on the treatment of advanced esophageal cancer.And some adverse events such as thrombocytopenia,diarrhea,and mucositis were caused.The combined treatment must be applied with to patients with advanced esophageal cancer.