鼻咽癌调强放疗时代诱导化疗后序贯放疗±同步化疗疗效与安全性的Meta分析

Meta-analysis of efficacy and safety of induction chemotherapy combined with radiotherapy±concurrent chemotherapy for nasopharyngeal carcinoma patients in the era of intensity-modulated radiation therapy

目的Meta分析调强放疗时代鼻咽癌诱导化疗(IC)联合单纯放疗(RT)与诱导化疗联合同步放化疗(CCRT)的疗效和不良反应。方法选择已经发表的回顾性或者随机对照临床研究,检索Cochrane图书馆、PubMed、Web of Science数据库,以2010—2020年发表的研究为主要研究对象。选择的研究包括接受IC+CCRT或IC+RT治疗的鼻咽癌患者,使用STATA 12软件合并风险比(HR)、危险比(RR)及95%可信区间(CI),并应用随机或固定效应模型进行统计学分析。结果共纳入了8项回顾性研究中的2483例患者。IC+CCRT组与IC+RT组总生存相仿(HR=0.78,95%CI为0.58~1.04,P=0.091);但IC+CCRT组的无远处转移生存(HR=0.56,95%CI为0.42~0.74,P<0.001)及无进展生存期(HR=0.65,95%CI为0.54~0.77,P<0.001)较IC+RT组提高。IC+CCRT组急性不良反应较IC+RT组明显增加。结论鼻咽癌治疗中两种治疗模式总生存相当,而IC+CCRT组的无远处转移生存及无进展生存较优于IC+RT组,但不良反应发生率也相应增加。IC+CCRT或许可作为鼻咽癌患者的一种推荐治疗方式,但需要更多研究。

Objective To compare the efficacy and adverse events of induction chemotherapy combined with radiotherapy alone(IC+RT)and induction chemotherapy combined with concurrent chemoradiotherapy(IC+CCRT)for nasopharyngeal carcinoma in the era of intensity-modulated radiation therapy in this Meta-analysis.Methods Retrospective or randomized controlled clinical studies published between 2010 and 2020 were searched from the Cochrane Library,PubMed,and Web of Science databases.The selected studies included nasopharyngeal carcinoma patients treated with IC+CCRT or IC+RT.STATA 12software was used to combine the hazard ratio(HR),risk ratio(RR)and 95%confidence interval(CI),and random or fixed effect models were used for statistical analysis.Results A total of 2483 patients from eight retrospective studies were included.The overall survival in the IC+CCRT group was similar to that in the IC+RT group(HR=0.78,95%CI:0.58-1.04,P=0.091).However,the distant metastasis-free survival(HR=0.56,95%CI:0.42-0.74,P<0.001)and progression-free survival(HR=0.65,95%CI:0.54-0.77,P<0.001)were improved in the IC+CCRT group compared with those in the IC+RT group.In terms of adverse reactions,the acute adverse reactions in the IC+CCRT group were increased significantly compared with those in the IC+RT group.Conclusions In the treatment of nasopharyngeal carcinoma,the overall survival of two treatment modes is similar,but the distant metastasis-free survival and progression-free survival in the IC+CCRT group are better than those in the IC+RT group,whereas the incidence of adverse reactions is also increased.IC+CCRT may be a recommended treatment for nasopharyngeal carcinoma patients,but more research is needed.