EGFR单抗联合放化疗对Ⅱ〜Ⅳb期鼻咽癌远期疗效的Meta分析

Meta-Analysis of Long-Term Efficacy of Anti-EGFR Monoclonal Antibody Combined with Chemoradiotherapy for Patients with Stage Ⅱ-Ⅳb Nasopharyngeal Carcinoma

目的:评估表皮生长因子受体(epidermal growth factor receptor,EGFR)单抗联合放化疗对比单纯放化疗治疗Ⅱ-Ⅳb期鼻咽癌的远期疗效。方法:计算机检索Pubmed、the Cochrane Library、Embase、CNKI、万方、CBM及维普等数据库,应用RevMan5.4版软件进行Meta分析。结果:共纳入23篇文献,4581例Ⅱ-Ⅳb期鼻咽癌患者进行分析。结果提示,EGFR单抗联合放化疗在3年总生存率、3年无远处转移生存率、5年无远处转移生存率上显著优于放化疗(P<0.05);但在3年无进展生存率、5年总生存率、5年无进展生存率无明显差异(P>0.05)。在3、5年总生存率中,按化疗方式不同分析得出同步放化疗联合EGFR单抗(部分加诱导化疗)疗效显著优于单纯放化疗,而诱导化疗+放疗+EGFR单抗治疗与单纯放化疗无明显差异。结论:EGFR单抗联合同步放化疗(部分加诱导化疗)可提高中晚期鼻咽癌远期预后,诱导化疗+放疗+EGFR单抗虽未能提高远期预后,但与同步放化疗疗效无明显差异,可作为不能耐受化疗患者的新选择。此结论仍需大量随机临床研究加以论证。

Objective:To evaluate the long-term efficacy of anti-epidermal growth factor receptor(EGFR)monoclonal antibody combined with chemoradiotherapy versus chemoradiotherapy alone in the treatment of stage Ⅱ-Ⅳb nasopharyngeal carcinoma.Methods:Articles from Pub Med,the Cochrane Library,Embase,CNKI,Wanfang,CBM and VIP databases were searched.Review manager 5.4 was used for meta-analysis.Results:A total of 23 articles were included,and 4,581 patients with stage Ⅱ-Ⅳb nasopharyngeal carcinoma were analyzed.Anti-EGFR monoclonal antibody combined with chemoradiotherapy demonstrated a significantly higher 3-year overall survival(OS),3-year distant metastasis free survival(DMFS)and 5-year DMFS than the single use of chemoradiotherapy(P<0.05);there were no significant differences in 3-year progression free survival(PFS),5-year OS and 5-year PFS(P>0.05).The concurrent chemoradiotherapy(CCRT)plus anti-EGFR monoclonal antibody regimen[induction chemotherapy(IC)was also used in some studies]was significantly better than that of chemoradiotherapy alone in both 3-year and 5-year OS;and there were no significant differences between the regimen of IC,radiotherapy and anti-EGFR monoclonal antibody and that of chemoradiotherapy alone.Conclusion:The CCRT plus anti-EGFR monoclonal antibody regimen(IC was also used in some studies)help improve the long-term prognosis of advanced nasopharyngeal carcinoma patients.The regimen of IC,radiotherapy and anti-EGFR monoclonal antibody resembles CCKT in efficacy,without a noticeable increased long-term prognosis though,serving as a new choice for patients who can not tolerate chemotherapy.This conclusion,however,still needs to be demonstrated by a large number of randomized clinical studies.