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1.
目的评价剂量密集型化疗方案与标准剂量方案治疗高分化骨肉瘤患者的5年无瘤生存率。方法采用Cochrane系统评价的方法,检索MEDLINE、Embase等图书馆临床对照试验数据库等。检索时间截止2012年10月。对同质研究进行统计学分析。结果共纳入5个研究、1 434例高分化骨肉瘤患者。剂量密集组在5年无瘤生存率[RR1.08,95%CI(0.96,1.21)],与标准剂量组差异无统计学意义;而术前化疗组织学反应良好,与不良的5年无瘤生存率[RR1.57,95%CI(1.36,1.82)]差异有统计学意义。结论肿瘤对术前化疗的组织学反应是骨肉瘤的一项独立预后因素。在临床应用中应根据具体情况选择合适的剂量,期待将来有更高质量的随机对照试验提供更可靠的数据  相似文献   

2.
目的系统评价大剂量化疗后自体干细胞移植一线治疗滤泡性淋巴瘤的临床疗效与安全性。方法计算机检索MEDLIN(E1990~2009)、EMbase(1990~2009)、OVID(1990~2009)和Cochrane图书馆(2009年第2期),手工检索美国血液年会(ASH)会议记录及相关文献的参考文献,评价纳入研究的方法学质量,采用STATA10.0软件和RevMan4.3软件进行统计分析。结果共纳入4个随机对照试验,包括941例患者。Meta分析结果显示:大剂量化疗后自体干细胞移植一线治疗滤泡性淋巴瘤与常规化疗相比,总生存率[RR=1.02,95%CI(0.94,1.11),P=0.59]、总缓解率[RR=0.96,95%CI(0.71,1.30),P=0.78]、继发恶性肿瘤发生率方面,两组差异无统计学意义,但在无事件生存率方面[RR=1.61,95%CI(1.25,2.07),P=0.000-2],大剂量化疗后自体干细胞移植治疗优于常规治疗。结论现有证据表明,大剂量化疗后自体干细胞移植一线治疗滤泡性淋巴瘤与常规化疗相比,不能改善患者的总生存率及总缓解率,但能提高无事件生存率,不增加继发恶性肿瘤发生的风险。本研究纳入病例数较少,结论尚需高质量多中心大样本随机对照试验证实。  相似文献   

3.
目的 评价化疗治疗软组织肉瘤的疗效是否优于非化疗。 方法 采用Cochrane 系统评价方法,计算机检索MEDLINE(1966 ~ 2008.12)、EMbase(1984 ~ 2008.12)、OVID database(1980 ~ 2008.12)、Cochrane Library临床对照试验数据库(2008 年第1 期)和中国生物医学文献光盘数据库(1980 ~ 2008.12),并追索所有纳入文献的参考文献,手工检索《中华肿瘤杂志》、《中国肿瘤临床》、《肿瘤》(均自创刊至2008.12)等。由两名评价者共同评价纳入研究质量,对同质研究进行Meta 分析。 结果 共纳入6 个RCT、共计836 例原发非转移性高分化软组织肉瘤患者。所有研究均未描述具体的随机方法、是否采用分配隐藏及盲法,但均报告了失访与退出原因以及基线资料。化疗组5 年总生存率[RR= 0.90,95%CI(0.76,1.06)]、局部复发率[OR= 0.69,95%CI(0.36,1.32)]、转移复发率[OR=0.83,95%CI(0.62,1.11)]和总复发率[RR= 0.91,95%CI(0.78,1.06)]与对照组相比,差异无统计学意义,但5 年无瘤生存率与对照组相比,差异有统计学意义[RR= 0.73,95%CI(0.63,0.86)]。 结论 现有研究结果显示,化疗治疗软组织肉瘤并不优于非化疗。但由于纳入研究存在选择性偏倚、实施偏倚、以及发表偏倚的中度可能性,很可能影响结果的可靠性,因此期望高质量的随机对照试验来提供更可靠的证据。  相似文献   

4.
健脾中药减少大肠癌患者化疗不良反应的系统评价   总被引:3,自引:0,他引:3  
目的评价健脾中药对大肠癌患者化疗后不良反应的改善作用。方法计算机检索中国生物医学文献光盘数据库(CBMdisc)、中国期刊全文数据库(CJFD)、万方数据医药信息系统(WangfangData)和PubMed,收集化疗联合健脾中药与单纯化疗比较的随机对照试验。检索时间为1966年至2007年9月。对纳入随机对照试验进行质量评价,并采用Cochrane协作网提供的RevMan5软件进行Meta分析。结果共纳入6个随机对照试验,包括334例患者,其中试验组188例,对照组146例,但纳入研究方法学质量均为C级。Meta分析结果显示,化疗联合健脾中药可减少Ⅰ、Ⅱ度白细胞降低[Ⅰ度:RR=0.50,95%CI(0.31,0.80);Ⅱ度:RR=0.37,95%CI(0.21,0.66)];与单纯化疗比较,Ⅱ度恶心呕吐发生率差异有统计学意义[RR=0.51,95%CI(0.31,0.84)],而神经系统毒性发生率差异无统计学意义。结论化疗与健脾中药联用可能降低大肠癌患者化疗的轻中度不良反应,如白细胞降低、恶心呕吐等,但缓解化疗药物神经毒性作用有限。由于纳入研究方法学质量不高,故此结论尚有待高质量、大样本的随机对照试验进一步证实。  相似文献   

5.
目的系统评价奈达铂联合化疗与顺铂联合化疗比较治疗晚期非小细胞肺癌的有效性和安全性。方法计算机检索Cochrane Library、PubMed、EMbase、CBM、VIP和WanFangData数据库,检索时限均为建库至2012年1月,收集关于奈达铂联合化疗与顺铂联合化疗比较治疗晚期非小细胞肺癌的随机对照试验(RCT)。由两位研究者按照纳入与排除标准筛选文献、提取资料和评价质量后,采用RevMan5.0软件进行Meta分析。结果共纳入15个RCT,1076例患者。Meta分析结果显示:与顺铂联合化疗比较,奈达铂联合化疗能降低恶心呕吐[RR=0.56,95%CI(0.48,0.65),P〈0.00001]、肾功能损伤[RR=0.47,95%CI(0.30,0.74),P=0.001]的风险,但会增加血小板减少的风险[RR=1.59,95%CI(1.20,2.11),P=0.00130在客观缓解率[RR=1.09,95%CI(0.92,1.29),P=0.03]、白细胞减少[RR=I.05,95%CI(0.92,1.19),P=0.50]及血红蛋白减少[RR=0.92,95%CI(0.80,1.07),P=0.30]方面,两组差异均无统计学意义。结论奈达铂联合化疗与顺铂联合化疗比较治疗晚期非小细胞肺癌,奈达铂联合化疗能显著降低恶心呕吐以及肾功能损伤发生的风险,但两组客观缓解率相当,奈达铂联合化疗发生血小板减少的风险更高。受纳入研究质量限制和可能存在的发表偏倚影响,上述结论尚需更多高质量的随机对照试验加以验证.  相似文献   

6.
目的系统评价患者输注高剂量血小板和低剂量血小板的效果。方法计算机检索PubMed、Embase、Cochrane图书馆和中国生物医学文献数据库,检索年限从建库至2011年12月。纳入高剂量与低剂量血小板输注的随机对照试验(RCT)。采用RevMan5.0软件进行Meta分析。结果研究共纳入6个RCT。输注高剂量血小板的患者再次输注血小板的时间间隔长于输注低剂量血小板的患者[MD=1.05,95%CI(O.89,1.20),P〈0.001],输注后血小板计数增加值高于输注低剂量血小板的患者[MD=17.38,95%CI(14.58,20.18),P〈0.001],但出血频率两组间差异无统计学意义[RR-0.77,95%CI(0.48,1.23),P=0.273。结论与输注低剂量血小板相比,输注高剂量血小板可以延长患者再次输注血小板的时间间隔,提高患者输注后的血小板计数,但对出血频率无显著影响。  相似文献   

7.
目的系统评价卡介苗联合化疗药物交替膀胱灌注与单用卡介苗膀胱灌注预防表浅性膀胱癌TURB-t术后复发的临床疗效和不良反应。方法电子检索PubMed(1950~2006.12)﹑OVID(1966~2006.12)﹑EMbase(1984~2006.12)﹑Cochrane图书馆(2006年第4期)、中国生物医学文献数据库(1978~2006)和维普中文科技期刊数据库(1989~2006),并手工检索已发表和未发表文献,纳入卡介苗联合化疗药物交替膀胱灌注预防表浅性膀胱癌TURB-t术后复发的随机对照试验,按Cochrane系统评价方法对纳入研究进行质量评价,并采用RevMan4.2.9软件进行Meta分析。结果共纳入4个随机对照试验,包括681例表浅性膀胱癌患者。Meta分析结果显示,卡介苗联合化疗药物交替膀胱灌注与单用卡介苗膀胱灌注相比,①对于Ta和T1期表浅性膀胱癌,复发率差异有统计学意义[RR合并0.69,95%CI(0.53,0.90)];②对于Tis期表浅性膀胱癌,复发率差异无统计学意义[RR1.22,95%CI(0.97,1.54)];③不良反应发生率差异无统计学意义[RR合并0.85,95%CI(0.70,1.03)]。结论卡介苗联合化疗药物交替膀胱灌注与单用卡介苗膀胱灌注相比,对于Ta和T1期表浅性膀胱癌,前者能有效降低TURB-t术后肿瘤复发率;对于Tis期膀胱癌,两者在TURB-t术后肿瘤复发率差异无统计学意义;在副作用发生率方面,两者差异也无统计学意义。但由于本系统评价纳入研究数量少,且存在选择偏倚、实施偏倚以及发表偏倚的中度可能性,很可能影响结果的可靠性,故应谨慎看待以上结论,期待更多高质量的随机对照试验提供更可靠的证据。  相似文献   

8.
恩度联合化疗治疗非小细胞肺癌的系统评价   总被引:1,自引:0,他引:1  
目的系统评价血管内皮抑制素(恩度)联合化疗与单独化疗比较治疗非小细胞肺癌的疗效及部分不良反应。方法计算机检索Cochrane图书馆、MEDLINE、EMbase、CBM、CNKI、VIP等数据库,查找恩度联合化疗与单独化疗比较治疗非小细胞肺癌的随机对照试验(RCT),检索时间截至2010年3月。由2名评价者按纳入排除标准选择文献、提取资料并评价方法学质量后,采用RevMan 5.0软件进行Meta分析。结果恩度为我国自主研发的血管内皮抑制素,仅纳入14个在国内完成的RCT,共1219例患者。14个研究均声称"随机",但仅2个研究报告了具体随机方法,所有研究均未详细报道是否采用盲法。Meta分析结果显示:恩度联合化疗在有效率[RR=1.76,95%CI(1.47,2.09)]、临床受益率[RR=1.43,95%CI(1.10,1.86)]方面高于单纯化疗且血小板减少的发生率较低[RR=0.77,95%CI(0.62,0.96)];而两组在白细胞减少[RR=0.94,95%CI(0.83,1.06)]、贫血[RR=0.94,95%CI(0.79,1.13)]、恶心呕吐[RR=1.04,95%CI(0.91,1.18)]、肝肾功能损害发生率[RR=0.63,95%CI(0.25,1.60)]方面,差异无统计学意义。结论恩度联合化疗能提高患者对药物治疗的有效率及临床受益率,并能减轻化疗部分相关不良反应,但由于纳入研究的方法学质量欠佳,影响了结论的可信度,我们期待未来进行更多大样本、高质量的随机对照双盲试验以证实。  相似文献   

9.
目的系统评价肾移植术后环孢素A低剂量与常规剂量比较的免疫抑制效果和安全性。方法计算机检索MEDLINE、EMbase、SCI、CBM、Cochrane图书馆检索时间均从建库至2009年12月,纳入肾移植术后环孢素A低剂量与常规剂量比较进行免疫抑制治疗的随机对照试验(RCT)。在评价纳入研究的方法学质量和提取有效数据后,采用RevMan5.0进行Meta分析。结果共纳入6个RCT,包括1551例患者,质量评价结果显示4个研究为A级、2个为B级。Meta分析结果显示:随访6个月及12个月两组急性排斥反应发生率[RR=1.07,95%CI(0.69,1.65);RR=1.06,95%CI(0.71,1.57)]、受者病死率[RR=0.64,95%CI(0.20,2.03);RR=0.61,95%CI(0.30,1.24)];以及移植物丢失率[RR=0.72,95%CI(0.38,1.36);RR=0.82,95%CI(0.54,1.25)]差异均无统计学意义,肾脏功能及纳入分析的安全性指标差异均无统计学意义。结论基于当前临床证据,肾移植术后CsA低剂量与常规剂量相比,近期疗效和安全性相似;远期结果有待进一步研究探讨。  相似文献   

10.
目的:探讨中药干预对乳腺癌患者无病生存率及总生存率的影响.方法:检索PubMed、Embase、Cochrane Library、 CNKI、Wanfang Data以及VIP,搜集相关期刊文献、学位论文及会议论文,检索时间从建库至2020年6月20日,对符合本研究纳入标准的文献数据使用RevMan 5.3软件进行统计学分析.结果:最终纳入16篇RCT,共2379例患者.Meta分析显示,2组患者5年总生存率[OR=2.81,95%CI(1.96,4.04)]、3年总生存率[OR=2.92,95%CI(2.12,4.01)]、5年无病生存率[OR=1.97,95%CI(1.41,2.77)]、3年无病生存率[OR=3.35,95%CI(2.41,4.67)]差异有统计学意义.结论:中药干预能提高乳腺癌患者5年、3年总生存率及无病生存率,使患者在治疗中获益.  相似文献   

11.
干扰素维持治疗小细胞肺癌的Meta分析   总被引:1,自引:0,他引:1  
目的系统评价干扰素(IFN)维持治疗小细胞肺癌(SCLC)的临床疗效。方法采用Cochrane系统评价的方法,电子检索MEDLINE (1966-2006.1)、EMbase(1984-2006.1)、Cochrane图书馆(2006年第1期)、中国生物医学文献数据库(1980-2006.1),手工检索相关会议的Education Book及相关试验的参考文献。评价纳入研究的方法学质量,提取有效数据,采用RevMan 4.2.7软件进行Meta分析。结果共纳入5个随机对照试验,587例患者。Meta分析结果显示,SCLC化疗缓解后应用IFN维持治疗不能改善患者的1年及2年生存率,其RR(95%CI)分别为1.19(0.88,1.61)和1.44(0.99,2.10),而应用IFN-α可以明显改善患者1年及2年生存率,其RR(95%CI)分别为2.08(1.16,3.72)和2.99(1.13, 7.93)。结论SCLC化疗缓解后应用IFN-α维持治疗可以改善患者的1年及2年生存率,但需大样本多中心随机对照试验进一步证实此结果。  相似文献   

12.
13.
《Clinical therapeutics》2020,42(3):515-543.e31
PurposeChemotherapy-induced hepatorenal toxicity often decreases tolerance for further therapies and results in poor quality of life and prognosis for patients with lung cancer. In this meta-analysis, all related studies were systematically re-evaluated to determine whether Aidi injection relieves hepatorenal toxicity and improves tumor response, and to determine its threshold and the optimal treatment regimen for obtaining the desired responses.MethodsAll studies regarding Aidi injection with chemotherapy were gathered from Chinese and English databases (from inception until January 2019). Their bias risk was evaluated and the data were synthesized using meta-analysis; the quality of evidence of all outcomes was rated by using the Grades of Recommendation Assessment, Development, and Evaluation approach.FindingsEighty randomized controlled trials containing 6279 patients were included in the study. Most of the trials showed unclear risk of bias. Aidi injection with chemotherapy increased the objective response rate (risk ratio [RR], 1.32; 95% CI, 1.25–1.40) and the disease control rate (RR, 1.15; 95% CI, 1.12–1.17) and resulted in a lower incidence of hepatotoxicity (RR, 0.61; 95% CI, 0.55–0.69) and nephrotoxicity (RR, 0.62; 95% CI, 0.53–0.72) than that of chemotherapy alone. Subgroup analyses showed that treatment with 50 mL per time, 10 to 14 days per cycle, and 2 to 3 cycles of Aidi injection with chemotherapy resulted in a low incidence of hepatorenal toxicity. All of the results were robust, and their quality was moderate.ImplicationsThe moderate evidence indicates that Aidi injection with chemotherapy may improve tumor response and result in a low incidence of hepatorenal toxicity in patients with lung cancer. Aidi injection may relieve hepatorenal toxicity and exhibit an important protective effect against chemotherapy-induced hepatorenal toxicity. Based on the subgroup analysis results, Aidi injection seems to lower the threshold for chemotherapy. Treatment with 50 mL per time, 10 to 14 days per cycle, and 2 to 3 cycles may be the optimal usage for attaining a decrease in hepatorenal toxicity.  相似文献   

14.
ObjectiveTo determine how many patients with chronic osteoarthritis pain respond to various non-surgical treatments.Data sourcesPubMed and the Cochrane Library.Study selection Published systematic reviews of randomized controlled trials (RCTs) that included meta-analysis of responder outcomes for at least 1 of the following interventions were included: acetaminophen, oral nonsteroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs, serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, cannabinoids, counseling, exercise, platelet-rich plasma, viscosupplementation, glucosamine, chondroitin, intra-articular corticosteroids, rubefacients, or opioids.Synthesis In total, 235 systematic reviews were included. Owing to limited reporting of responder meta-analyses, a post hoc decision was made to evaluate individual RCTs with responder analysis within the included systematic reviews. New meta-analyses were performed where possible. A total of 155 RCTs were included. Interventions that led to more patients attaining meaningful pain relief compared with control included exercise (risk ratio [RR] of 2.36; 95% CI 1.79 to 3.12), intra-articular corticosteroids (RR = 1.74; 95% CI 1.15 to 2.62), SNRIs (RR = 1.53; 95% CI 1.25 to 1.87), oral NSAIDs (RR = 1.44; 95% CI 1.36 to 1.52), glucosamine (RR = 1.33; 95% CI 1.02 to 1.74), topical NSAIDs (RR = 1.27; 95% CI 1.16 to 1.38), chondroitin (RR = 1.26; 95% CI 1.13 to 1.41), viscosupplementation (RR = 1.22; 95% CI 1.12 to 1.33), and opioids (RR = 1.16; 95% CI 1.02 to 1.32). Preplanned subgroup analysis demonstrated no effect with glucosamine, chondroitin, or viscosupplementation in studies that were only publicly funded. When trials longer than 4 weeks were analyzed, the benefits of opioids were not statistically significant.ConclusionInterventions that provide meaningful relief for chronic osteoarthritis pain might include exercise, intra-articular corticosteroids, SNRIs, oral and topical NSAIDs, glucosamine, chondroitin, viscosupplementation, and opioids. However, funding of studies and length of treatment are important considerations in interpreting these data.  相似文献   

15.
BACKGROUND: The cardiovascular (CV) safety of non-steroidal anti-inflammatory drugs (NSAIDs) and selective cyclooxygenase-2 inhibitors has been the subject of considerable debate. OBJECTIVE: The objective of this study was to determine the risk of CV events with lumiracoxib by meta-analysis of all completed, randomized controlled trials (RCTs) of > or =1 week and up to 1 year in duration of patients with osteoarthritis and rheumatoid arthritis. METHODS: The Novartis Lumiracoxib Clinical Trial Database, which includes all clinical studies conducted to date with lumiracoxib, was reviewed. Data were extracted from RCTs of > or =1 week and up to 1 year in duration, the maximum study duration; 34,668 patients were included in standard and cumulative meta-analyses. Twenty-two RCTs of lumiracoxib 100 to 1200 mg daily were identified; 22,781 patients were included in 1-year trials. Mean age of the patients was 61.5 years and 74% were female. More than 50% of the patients in these studies had hypertension at baseline and 6% had diabetes. Parameters analyzed were the Antiplatelet Trialists' Collaboration (APTC) composite CV end point of myocardial infarction (MI), stroke (ischemic and hemorrhagic), and CV death; MI alone; and stroke alone. Twenty-one of the 22 RCTs have been published. RESULTS: For all 3 parameters, relative risk (RR) was calculated versus non-naproxen NSAIDs, naproxen, and placebo. The results were as follows: for the APTC end point versus non-naproxen NSAIDs: RR 0.83, 95% CI, 0.46-1.51; versus naproxen: RR 1.49, 95% CI, 0.94-2.36; versus placebo: RR 1.08, 95% CI, 0.41-2.86; for MI alone versus non-naproxen NSAIDs: RR 0.80, 95% CI, 0.28-2.25; versus naproxen: RR 1.69, 95% CI, 0.82-3.48; versus placebo: RR 1.27, 95% CI, 0.25-6.56; and for stroke alone versus non-naproxen NSAIDs: RR 0.91, 95% CI, 0.35-2.35; versus naproxen: RR 1.42, 95% CI, 0.70-2.91; versus placebo: RR 0.59, 95% CI, 0.13-2.74. Cumulative meta-analyses of lumiracoxib versus all comparators (placebo, diclofenac, ibuprofen, celecoxib, rofecoxib, and naproxen) did not find any significant differences in APTC, MI alone, or stroke alone. CONCLUSION: This meta-analysis of 34,668 patients receiving > or =1 week and up to 1 year of treatment found no evidence that lumiracoxib was associated with a significant increase in CV risk compared with naproxen, placebo, or all comparators (placebo, diclofenac, ibuprofen, celecoxib, rofecoxib, and naproxen).  相似文献   

16.
目的 探讨静脉留置针行股静脉穿刺输液在神经外科脑疝患者术前抢救中的意义.方法 将我科334 例单侧瞳孔散大的脑疝患者采用随机数字表法随机分为三组.A 组(外周静脉输液组):静脉留置针行外周静脉穿刺输液120 例.B组(中心静脉输液组):中心静脉穿刺置管输液102 例.C 组(静脉留置针行股静脉输液组):静脉留置针行股静脉穿刺输液112 例.比较三组患者穿刺成功所需时间(T1 )、输注20%甘露醇250 ml 所需时间(T2 )、术前瞳孔回缩例数.结果 T1 :A 组为(2.16 ±0.82)min,B 组为(11.73 ±4.43)min,C 组为(2.29 ±0.92)min.经t 检验:PAB <0.05,PBC <0.05,PAC >0.05.T2 :A 组为(35.78 ±1.69)min ,B 组为(19.74 ±1.97)min,C 组为(19.81 ±2.03)min.经t 检验:PAB <0.05,PBC >0.05,PAC<0.05.瞳孔回缩例数:A 组为18 例,B 组为20 例,C 组为36 例.经χ2 检验:χ2 =0.825,PAB >0.05,χ2 =4.341,PBC <0.05,χ2 =9.533,PAC <0.01.结论 静脉留置针行股静脉穿刺置管输液能快速建立输液通道,且输液速度快,能够快速有效输注20%甘露醇等高渗脱水降颅内压抢救药物,迅速降低颅内压,缓解脑疝,为进一步手术治疗赢得时间,效果优于外周静脉输液及中心静脉输液,且并发症低,在神经外科脑疝患者的抢救中意义明显.  相似文献   

17.
新辅助放化疗对食管癌手术和预后的影响   总被引:3,自引:0,他引:3  
目的对术前放化疗(新辅助放化疗,CRTS)与单纯手术(S)治疗食管癌的随机对照试验研究(RCTs)进行Me-ta分析,探讨CRTS对食管癌手术及预后的影响。方法 PubMed及手工检索所有已发表的关于CRTS与S治疗食管癌的RCTs。检验异质性,并根据异质性结果选择相应的效应模型。结果 14项RCTs纳入本研究,共1737例食管癌患者,文献质量评价根据Cochrane Reviewers′ Handbook4.2.2为A或B。CRTS组与S组比较,1年生存率差异无统计学意义,但CRTS组2年、3年、4年、5年生存率明显提高。相对危险度(RR)分别为1.06(95%CI0.99~1.13;P=0.1)、1.18(95%CI1.04~1.33;P=0.01)、1.39(95%CI1.23~1.58;P<0.00001)、1.27(95%CI1.04~1.55;P=0.02)、1.41(95%CI1.18~1.69;P=0.0001)。切除率二者差异无统计学意义,RR1.01(95%CI0.97~1.05;P=0.67),但CRTS组有较高的完全切除率,RR1.44(95%CI1.23~2.74;P=0.008)。总体死亡率二者比较,差异无统计学意义,RR1.12(95%CI0.89~2.48;P=0.503),但CRTS组手术相关死亡率相对较高,RR1.70(95%CI1.12~2.56;P=0.01)。二者并发症发生率差异无统计学意义,RR1.23(95%CI0.93~1.78;P=0.13)。二组远处转移率及总体肿瘤复发率比较,均差异无统计学意义,RR分别为1.18(95%CI0.75~1.68;P=0.71)、1.07(95%CI0.76~1.56;P=0.18),但CRTS组局部区域复发率降低,RR1.18(95%CI1.22~1.61;P=0.0001)。CRTS组病理完全缓解率达10.0%~45.5%。同步CRTS与序贯性CRTS比较,前者(RR1.34,95%CI1.06~1.89,P=0.013)比后者(RR0.86,95%CI0.67~1.38,P=0.29)更有益于提高患者5年生存率。结论与S治疗食管癌相比,CRTS降低了肿瘤局部区域复发率,提高了患者的3年、5年生存率;手术切除率二者差异无统计学意义,而CRTS完全切除率提高,但其手术相关死亡率相对较高。二者并发症发生率比较差异无统计学意义。  相似文献   

18.
目的系统评价胰腺癌根治术后辅助化疗对胰腺癌根治术患者生存率的影响。方法计算机检索h e Cochrane Library(2013年第11期)、Pub Med、EMbase、CBM、CNKI、VIP和Wan Fang Data数据库,查找有关胰腺癌根治术后辅助化疗对胰腺癌根治术患者生存情况影响的随机对照试验(RCT),检索时限均为建库至2013年11月。由2位评价者按照纳入与排除标准独立筛选文献、提取资料并评价纳入研究的方法学质量后,采用Rev Man5.2软件进行Meta分析。结果共纳入7个RCT,包括1 079例患者,其中试验组544例,对照组535例。Meta分析结果显示,胰腺癌根治术后辅助化疗较单纯根治术能延长患者的总生存时间[WMD=5.45,95%CI(2.52,8.39),P=0.000 3],提高2年生存率[RR=1.17,95%CI(1.01,1.35),P=0.03]和5年生存率[RR=1.80,95%CI(1.24,2.62),P=0.002],其差异均有统计学意义。但两组在1年生存率方面差异无统计学意义[RR=1.02,95%CI(0.94,1.11),P=0.65]。结论现有证据表明,胰腺癌根治术后应接受术后辅助化疗。  相似文献   

19.

Background

Chemotherapy is essential for long-term survival of osteosarcoma patients. However, the impact of dosage and dosage intensity (DI) of chemotherapeutic agents on patients with high-grade osteosarcoma is largely unknown.

Objective

The object of this study was to evaluate the influence of these dosage-related variables on treatment outcomes in terms of event-free survival (EFS).

Methods

PubMed was searched for relevant English-language articles. Two reviewers extracted data independently. Sufficient data were presented to calculate the planned total dosage and DI for doxorubicin, cisplatin, ifosfamide, and methotrexate. Univariate analysis and partial regression analysis were performed to determine the association of 5-year EFS and the planned total dosage and DI of each drug.

Results

Seventeen studies comprising 23 trial arms met the inclusion criteria. The analysis recruited a total of 2257 patients. The study period ranged from 1976 to 2006. Using univariate analysis, the planned dosage and DI of methotrexate and ifosfamide correlated with better 5-year EFS (P = 0.001 for methotrexate dosage; P = 0.030 for ifosfamide dosage; P < 0.001 for methotrexate DI; and P = 0.033 for ifosfamide DI). There was a trend toward worse 5-year EFS with increase of doxorubicin DI (P = 0.055). Based on the partial regression analysis, the association of doxorubicin DI and ifosfamide dosage and DI with EFS became no longer statistically significant, and the planned total dosage and DI of methotrexate remained significantly correlated with better 5-year EFS (P = 0.001 and P = 0.004, respectively).

Conclusions

We observed a correlation of higher planned methotrexate total dosage and DI with better treatment outcomes in osteosarcoma patients. The present study showed that methotrexate dosage and DI were important predictors of the clinical outcomes and provided the rationale of high-dosage methotrexate in the context of multi-agent chemotherapy.  相似文献   

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