晚期阴茎癌围手术期化疗疗效的荟萃分析

The efficacy of Perioperative Chemotherapy for Advanced Penile Cancer:a meta-analysis

目的评估围手术期化疗(新辅助化疗或辅助化疗)对晚期阴茎癌患者的治疗效果。方法本文收集了9篇相关研究进行Meta分析,比较晚期阴茎癌患者接受新辅助化疗或辅助化疗后,其总生存期(OS)、无疾病生存(RFS)以及2年、5年生存率的获益情况。结果辅助化疗对于提升阴茎癌患者OS以及2年生存率的获益并差异无统计学意义(RR=0.94,95%CI:0.39~2.25,P=0.89;RR=1.22,95%CI:0.86~1.72,P=0.27)。而相比于对照组(单纯手术组),新辅助化疗可显著提高患者OS获益(RR=0.28,95%CI:0.13~0.62,P=0.002)。而在应用新辅助化疗后,将对新辅助化疗有反应的患者,即完全缓解(CR)+部分缓解(PR),与对新辅助化疗无反应的患者,即疾病稳定(SD)+疾病进展(PD),相对比,对新辅助化疗有反应的患者,其5年生存率以及5年无疾病复发生存率均显著提高(RR=5.51,95%CI:2.32~13.07,P=0.002;RR=4.73,95%CI:1.59~14.10,P=0.005),而OS及RFS同样显著获益(RR=0.25,95%CI:0.12~0.51,P<0.001;RR=0.25,95%CI:0.13~0.50,P<0.001)。结论新辅助化疗可使晚期阴茎癌患者显著获益,有选择地对存在体积较大、固定、双侧同发的腹股沟淋巴结转移或盆腔淋巴结转移的高危患者应用新辅助化疗联合手术治疗,可以获得更好的生存获益。

Objective To evaluate whether the perioperative chemotherapy(neoadjuvant or adjuvant chemotherapy)can improve the treatment efficacy of patients with advanced penile squamous-cell carcinoma.Methods We conducted a comprehensive meta-analysis of 9 studies.Results The receipt of adjuvant chemotherapy did not statistically improve the overall survival(OS)or 2-year survival rate(RR=0.94,95%CI:0.39-2.25,P=0.89:RR=1.22,95%CI:0.86-1.72,P=0.27).However,neoadjuvant chemotherapy resulted in a significant OS benefit(RR=0.28,95%CI:0.13-0.62,P=0.002).What’s more,we found a statistically significant improvement in 5-year survival rate(RR=5.51,95%CI:2.32-13.07,P=0.002),5-year recurrence-free survival rate(RR=4.73,95%CI:1.59-14.10,P=0.005),OS(RR=0.25,95%CI:0.12-0.51,P<0.001)and RFS(RR=0.25,95%CI:0.13-0.50,P<0.001)among patients who experienced an objective response(CR+PR)to neoadjuvant chemotherapy compared with those who did not(SD+PD).Conclusions In conclusion,neoadjuvant chemotherapy treatment may represent an alternative to traditional treatment for patients with advanced penile squamous-cell carcinoma.