可切除食管鳞癌新辅助化疗对比新辅助同步放化疗的meta分析

Efficacy and safety of neoadjuvant chemotherapy versus neoadjuvant concurrent radiochemotherapy for resectable esophageal squamous cell carcinoma:a meta-analysis

目的系统评价新辅助化疗与新辅助同步放化疗治疗可切除食管鳞癌的临床疗效及安全性差异。方法计算机检索Web of Science、Pubmed、Cochrane library、Embase、中国知网、万方、中国生物医学文献数据库等,查找有关可切除食管鳞癌新辅助化疗对比新辅助同步放化疗的临床对照研究文献。相关结局指标通过Revman 5.3统计软件进行分析。结果最终纳入9项研究,共计1369例患者。新辅助化疗与新辅助同步放化疗相比,有较低的3年和5年总生存率(OR=0.68,95%CI:0.53~0.86,P<0.05;OR=0.51,95%CI:0.34~0.77,P<0.05)、较低的病理完全缓解率(OR=0.28,95%CI:0.18~0.45,P<0.05)及R0切除率(OR=0.39,95%CI:0.22~0.68,P<0.05),两组术后总体并发症发生率相近(OR=1.07,95%CI:0.75~1.51,P>0.05)。结论对于可切除食管鳞癌患者,新辅助同步放化疗可能优于新辅助化疗。

Objective To systematic review the clinical efficacy and safety of neoadjuvant chemotherapy and neoadjuvant concurrent chemoradiotherapy for resectable esophageal squamous cell carcinoma.Methods Literature search was performed from Web of Science,Pubmed,Cochrane Library,Embase,CBM,Wanfang Data,CNKI and Chongqing VIP.The clinical controlled studies of neoadjuvant chemotherapy versus neoadjuvant concurrent chemoradiation in the treatment of resectable esophageal squamous cell carcinoma was searched.Relevant outcome indicators were analyzed by Revman 5.3 statistical software.Results Nine studies were included,with a total of 1,369 patients.Compared with the neoadjuvant chemoradiotherapy,the neoadjuvant chemotherapy had lower overall survival rates at 3 and 5 years(OR=0.68,95%CI:0.53-0.86,P<0.05;OR=0.51,95%CI:0.34-0.77,P<0.05),lower pathological complete remission rate(OR=0.28,95%CI:0.18-0.45,P<0.05)and R0 resection rate(OR=0.39,95%CI:0.22-0.68,P<0.05),The total postoperative complication rate is similar(OR=1.07,95%CI:0.75-1.51,P>0.05).Conclusion Neoadjuvant concurrent radiochemotherapy maybe superior to neoadjuvant chemotherapy among patients with resectable esophageal squamous cell carcinoma.