术中放疗应用于胰腺癌的疗效与安全性meta分析

Efficacy and safety of intraoperative radiotherapy for pancreatic cancer: a meta-analysis

目的比较术中放疗(IORT)联合常规治疗(手术联合放化疗)与单纯常规治疗对胰腺癌疗效与安全性等预后的影响。方法全面检索PubMed、Cochrane Library、Web of Science、Embase、维普、知网、万方、中国生物医学文献服务系统(SinoMed)等数据库收录的文献, 对符合纳入标准的文献进行筛选并提取数据, 采用RevMan 5.4软件进行meta分析。结果共纳入11项研究, 共813例患者, 根据合并结果显示, 与单纯常规治疗相比, IORT联合常规治疗可提高胰腺癌的总体生存率(HR=0.66, 95%CI为0.54~0.81, Z=4.03, P<0.001), 且不会增加治疗相关不良反应(OR=1.00, 95%CI为0.69~1.46, Z=0.01, P=0.99), 但不能使局部控制率获益(HR=0.56, 95%CI为0.31~1.01, Z=1.93, P=0.05)。结论 IORT联合常规治疗组胰腺癌患者总体生存率明显优于单纯常规治疗组, 两组的不良反应无差异, 值得临床推广应用。

Objective To compare and analyze the efficacy and safety of intraoperative radiotherapy(IORT)combined with conventional therapy(surgery combined with radiochemotherapy)and conventional therapy alone for pancreatic cancer.Methods Literature review was conducted from PubMed,Cochrane Library,Web of Science,Embase,Chongqing VIP,CNKI,Wanfang Data and China Biomedical Literature Service System(SinoMed).The literatures that met the inclusion criteria were screened and the data were extracted.Meta-analysis was carried out by RevMan 5.4 software.Results A total of 11 studies consisting of 813 patients were included.According to the combined results,compared with conventional therapy,IORT combined with conventional therapy could improve the overall survival rate of pancreatic cancer(HR=0.66,95%CI=0.54-0.81,Z=4.03,P<0.001),and did not increase the treatment-related side effects(OR=1.00,95%CI=0.69-1.46,Z=0.01,P=0.99),but failed to bring benefit to the local control rate(HR=0.56,95%CI=0.31-1.01,Z=1.93,P=0.05).Conclusions The overall survival rate in the IORT combined with conventional therapy group is significantly better than that in the conventional therapy group.No significant difference is found in the treatment-related adverse reactions between two groups.IORT combined with conventional therapy is worthy of clinical application.