胃癌术后放化疗与单纯化疗随机对照试验结果的荟萃分析

目的 采用偱证医学荟萃分析的方法比较胃癌术后放化疗与单纯化疗的RCT结果差异。 方法 检索中国期刊全文数据库、维普、中国生物医学文献数据库,Cochrane图书馆、PubMed和EMBASE,纳入胃癌术后放化疗及单纯化疗的RCT研究。汇总数据采用RevMan5.2及Stata12软件进行分析。两组间差异采用RR及95%CI描述。 结果 根据纳入和排除标准,最终纳入11个1 143例患者的RCT资料。荟萃分析结果显示胃癌术后放化疗比单纯化疗的1、2、3年OS率高（RR=1.20,95%CI=1.10～1.30,P=0.00;RR=1.34,95%CI=1.16～1.56,P=0.00;RR=2.62,95%CI=1.72～3.97,P=0.00）;3、5年PFS率也高（RR=1.10,95%CI=1.00～1.21,P=0.04;RR=1.27,95%CI=1.02～1.60,P=0.04)。胃肠道反应、肝功能损害、骨髓移植及手足综合征等3~4级发生率低且两组相似（P=0.03~0.78）。结论 胃癌术后放化疗可提高生存时间,且患者对药物的耐受性尚可。     

可切除食管癌术前与术后放化疗对比Meta分析

目的 食管癌患者就诊时大多属中晚期,单纯手术疗效不佳,需结合放化疗提高疗效,但手术与放化疗治疗顺序备受争议.本研究通过对比中晚期可切除食管癌术前与术后放化疗2种治疗模式的疗效及安全性,探寻治疗食管癌的有效治疗模式,为指导临床实践提供理论依据.方法 计算机检索The Cochrane Library、Embase、PubMed、Web of Science、CBM和CNKI,同时辅佐其他检索途径,检索2016-10前所有关于对比食管癌术前放化疗与术后放化疗的临床研究.随机对照研究(randomized controlled trial,RCT)采用Cochrane质量评价标准评价文献质量,非随机对照研究采用纽斯卡尔-渥太华量表(newcastle-ottawa scale,NOS)质量评价标准评价文献质量,统计学分析采用Review Manager 5.3软件.本Meta分析遵循系统综述与荟萃分析优先报告条目(PRISMA)规范.结果 共纳入1个RCT和5个非随机对照研究,Meta分析结果显示,1年生存率(OR=1.24,95％CI:0.96～1.61,P=0.09)、3年生存率(OR=1.25,95％CI:1.00～1.55,P=0.05)、5年生存率(OR=1.39,95％CI:0.93～2.06,P=0.11)和术后并发症发生率(OR=1.45,95％CI:0.81～2.60,P=0.21)差异均无统计学意义.亚组分析显示,国内人群1年生存率(OR=1.30,95％CI:0.48～3.58,P=0.61)、国外人群1年生存率(OR=1.37,95％CI:0.79～2.38,P=0.26)、国内人群3年生存率(OR=1.16,95％CI:0.90～1.49,P=0.25)和国外人群3年生存率(OR=1.55,95％CI:1.00～2.41,P=0.05)差异均无统计学意义.结论 中晚期可切除食管癌术前放化疗与术后放化疗疗效及安全性相似.临床上可酌情考虑后决定手术与放化疗治疗顺序,但仍有待大量多中心、前瞻性随机对照临床实验证实.     

肝外胆管癌和胆囊癌术后辅助放疗与未放疗疗效比较的Meta分析

目的 采用Meta分析方法比较肝外胆管癌和胆囊癌术后辅助放疗与未放疗间的疗效差异。方法 计算机检索PubMed、EMbase、Cochrane图书馆、万方、维普、CNKI及中国生物医学等数据库,搜集有关肝外胆管癌和胆囊癌术后辅助放疗与未放疗比较的临床对照研究资料,汇总数据采用RevMan5.3和Stata14.0软件进行分析。两组间差异采用OR及 95%CI描述。结果 最终纳入20个包括 1258例患者的临床对照研究资料。Meta分析结果显示,与肝外胆管癌和胆囊癌术后未行放疗相比,辅助放疗组 5年生存率更高(OR=1.67,95%CI为 1.29~2.18,P=0.001)。术后辅助放疗能明显提高切缘阳性(OR=3.43,95%CI为 1.56~7.75,P=0.002)以及淋巴结阳性(OR=7.44;95%CI为1.24~44.72,P=0.03)患者的 5年生存率。此外,术后辅助放疗组的局部复发率更低(OR=0.56,95%CI为 0.39~0.80,P=0.01),但远处转移率两组相似(OR=1.22,95%CI为 0.86~1.73,P=0.270)。放疗所致≥3级急性毒性及慢性毒性反应发生率分别为 0~11.9%和 0~21.7%。结论 与肝外胆管癌和胆囊癌术后未行放疗相比,术后辅助放疗是有效且安全的治疗方法。     

进展期胃癌新辅助化疗疗效评价：16个随机试验的荟萃分析

[目的]评价新辅助化疗(neoadjuvant chemotherapy,NAC)在进展期胃癌中的安全性和有效性.[方法]在Pubmed、Cochrane library和EMbase等数据库中检索1990年1月至2015年9月发表的有关NAC的随机对照试验(randomized controlled triALs,RCTs),由两位独立的研究人员进行文献筛选和数据提取.采用RevMan 5.3软件进行荟萃分析.[结果]共纳入16项RCTs,共2077例患者(NAC组308例,对照组316例).结果显示NAC较对照组能提高进展期胃癌的总体生存率(HR=0.74,95％CI:0.63～0.88,P=0.0006)、5年生存率(OR=1.61,95％CI:1.24～2.09,P=0.0004)和3年无病生存期(HR=0.66,95％CI:0.56～0.77,P＜0.00001),能降低肿瘤术前分期(OR=1.71,95％CI:1.26～2.33,P=0.0006),NAC组的R0手术切除率显著性高于对照组(OR=1.55,95％CI:1.22～1.97,P=0.0003);而两组的术后并发症(OR=1.12,95％CI:0.87～1.44,P=0.40)、围术期死亡率(OR=1.14,95％CI:0.64～2.05,P=0.65)、3/4级化疗副反应发生率(P＞0.05)差异无统计学意义.[结论] NAC能提高进展期胃癌患者的生存率,提高手术切除率,降低肿瘤分期.其安全可行,患者可耐受.     

食管鳞癌新辅助放化疗术后化疗疗效分析

目的评价新辅助放化疗后可切除局部晚期食管鳞癌患者术后化疗的临床疗效。方法收集郑州大学附属肿瘤医院2005-01-01-2012-12-31接受新辅助放化疗加手术的192例局部晚期食管鳞癌患者,术前化疗共2个周期,方案为顺铂20mg/(m2·d)和氟尿嘧啶400mg/(m2·d)持续静脉滴入5d,同步放疗剂量为40Gy/20次,所有患者均成功接受手术。患者分组依据术前新辅助放化疗过程中出现的骨髓抑制程度,出现2度及以上骨髓抑制的122例患者术后未再接受其他治疗,即单纯新辅助放化疗加手术(A组);未出现2度及以上骨髓抑制的70例患者均接受术后化疗,即新辅助放化疗加手术结合术后化疗(B组)。B组患者术后接受1~4个周期的化疗,方案同术前化疗。结果 A组1、3和5年总生存率分别为87.4%、51.9%和43.5%,B组分别为93.0%、58.5%和48.8%,两组5年生存率差异无统计学意义,χ2=1.390,P=0.238。A组和B组5年无疾病进展生存率分别为34.0%和38.8%,差异有统计学意义,χ2=3.883,P=0.049。Cox分析结果显示,病理完全缓解(HR=1.420,95%CI为1.074~1.878,P=0.014,及淋巴结病理阴性(HR=1.979,95%CI为1.221~3.209,P=0.006)与较高的总体生存率相关,而且病理完全缓解(HR=1.273,95%CI为0.994~1.631,P=0.056,及淋巴结病理阴性(HR=1.753,95%CI为1.121~2.742,P=0.004)与较高的无疾病进展生存率亦相关。亚组分析显示,男性和未完全病理缓解患者的无疾病进展生存率从术后化疗中获益较多。结论术后化疗不能提高新辅助放化疗后可切除的局部晚期食管鳞癌的总体生存率,但可以提高该部分患者的无疾病进展生存率,尤其是男性及新辅助放化疗后未完全病理缓解的患者。     

局部晚期胃癌新辅助化疗的Meta分析

目的:应用Meta分析评价新辅助化疗在局部晚期胃癌综合治疗中的价值。方法:利用计算机检索PubMed、Embase、Cochrane Library、中国生物医学文献数据库(China Biology Medicine disc,CBMdisc)、中国知网(National Knowledge Infrastructure,CNKI)、中国期刊全文数据库(China Academic Journals Full-text Database,CJFD)、万方数据资源系统(Wanfang Data)、中国学术会议文献数据库和中国肿瘤防治数据库等。按照文献纳入标准和排除标准选择临床随机对照试验(randomized controlled trial,RCT)文献,评价文献质量,并提取资料,应用RevMan 5.0软件进行Meta分析。结果:终纳入8篇RCT文献,共1 260例患者。新辅助化疗联合手术治疗组与单纯手术组的手术切除率[优势比(odds ratio,OR)为1.04,95%可信区间(coni dence interval,CI)为0.76~1.43,P=0.79]、根治性手术切除率(OR为1.02,95%CI为0.57~1.83,P=0.94)和围手术期死亡率(OR为1.06,95%CI为0.56~2.00,P=0.86)差异均无统计学意义。两组的1年生存率差异无统计学意义(OR为1.05,95%CI为0.79~1.41,P=0.72),但新辅助化疗联合手术治疗组的2年生存率(OR为1.33,95%CI:1.03~1.72,P=0.03)和3年生存率(OR为1.61,95%CI为1.23~2.09,P=0.000 5)均高于单纯手术组。结论:局部晚期胃癌新辅助化疗不增加手术切除率和手术风险,可提高远期生存率。     

PRKAα1基因多态性与东亚人群胃癌易感性研究的meta分析

目的：综合评价PRKAα1基因5个单核苷酸多态性位点rs13361707C > T、rs10074991G > A、rs154268T > C、rs3805486T > C、rs6882903C > A多态性与东亚人群胃癌易感性的关系。方法：检索PubMed、中国知网、万方、维普等数据库收集关于PRKAα1基因多态性与胃癌易感性研究的文献。利用STATA 12.0软件计算比值比（OR）和95%可信区间（95% CI）,进行敏感性分析和发表偏倚的检测。结果：rs13361707C > T位点纳入9项研究,该位点多态性与东亚人群胃癌的易感性无统计学相关性。亚组分析显示,显性模型的合并OR=0.687,95% CI （0.614~0.769）,P=0.000;隐性模型的合并OR=0.662,95% CI （0.594~0.737）,P=0.000;加性模型的合并OR=0.553,95% CI （0.484~0.632）,P=0.000;共显性模型的合并OR=0.766,95% CI （0.682~0.859）,P=0.000;该结果提示在4种模型下韩国人群患胃癌风险降低。rs10074991G > A位点纳入3项研究,meta分析结果显示,显性模型的合并OR=0.590,95% CI （0.490~0.700）,P=0.000;隐性模型的合并OR=0.637,95% CI （0.535~0.759）,P=0.000;加性模型的合并OR=0.478,95% CI （0.385~0.593）,P=0.000;共显性模型的合并OR=0.651,95% CI （0.541~0.784）,P=0.000;该结果提示在4种模型下东亚人群患胃癌风险降低。亚组分析结果显示,在4种模型下韩国人群患胃癌风险降低。除隐性模型外,在其余3种模型下中国人群患胃癌风险降低。rs154268T > C、rs3805486T > C、rs6882903C > A这3个位点分别纳入2项研究,除隐性模型外,rs154268T > C位点在3种模型下韩国人群患胃癌风险增加,rs3805486T > C位点在4种模型下韩国人群患胃癌风险降低,rs6882903C > A位点在显性和加性模型下韩国人群患胃癌风险增加。Begg’s检测未发现发表偏倚（P > 0.05）,敏感性分析说明上述结果具有稳定性。结论：PRKAα1基因rs10074991G > A、rs154268T > C、rs3805486T > C、rs6882903C > A位点多态性与胃癌的易感性有关。     

食管鳞癌同期放化疗荟萃分析

目的 分析同期放化疗在我国非手术治疗食管鳞癌的疗效及不良反应,为其临床应用提供循证医学证据。方法 检索CNKI、万方医学网数据库中有关食管癌同期放化疗的随机对照研究,应用荟萃分析方法评价国内食管鳞癌同期放化疗的疗效及安全性。结果 纳入符合标准的随机或病例对照研究39项共4161例患者。荟萃分析显示同期放化疗较单纯放疗可明显提高食管癌患者的近期疗效(OR=2.588,P=0.000)和1、3、5年生存率(HR=1.995,P=0.000;HR=2.047,P=0.000;HR=2.265,P=0.000),但≥3级放射性食管炎、≥2级放射性肺炎及≥3级骨髓抑制发生率也显著升高(OR=4.372,P=0.000;OR=1.962,P=0.005;OR=4.403,P=0.000)。同期放化疗含紫杉类方案较FP方案可提高近期疗效(OR=1.868,P=0.036),1、3年生存率相似(HR=1.087,P=0.781;HR=1.315,P=0.569)。     

诱导化疗+同期放化疗对局部晚期NSCLC临床价值的Meta分析

目的 应用Meta分析方法评估同期放化疗前加诱导化疗在治疗局部晚期NSCLC中的价值。方法 检索中国生物医学文献数据库、中国学术期刊全文数据库、Cochrane Library、Pubmed、EMbase国内外数据库有关局部晚期NSCLC患者诱导化疗+同期放化疗与同期放化疗对比的文献,依据入选和排除标准收集各项研究的近期疗效及生存情况,应用Meta分析方法评价同期放化疗前加诱导化疗的临床疗效。结果 纳入符合标准的国内外文献5篇,共包括 845例患者。结果显示诱导化疗+同期放化疗较同期放化疗在近期疗效及2、3年生存率方面均相近(OR=0.875,95% CI为 0.507~1.510,P=0.631;HR=0.770,95% CI为 0.515~1.151,P=0.203;HR=0.809,95% CI为 0.559~1.172,P=0.262),但≥3级白细胞下降发生率明显增加(OR=0.637,95% CI为 0.435~0.931,P=0.020)。结论 同期放化疗前加诱导化疗在近期疗效和2、3年生存率并未显示优势,而骨髓抑制明显增加。限于纳入研究较少,病例数偏少,尚需开展多中心随机研究提供更为详实的数据来进一步明确诱导化疗+同期放化疗的临床价值。     

直肠癌术后三维适形/调强放疗联合化疗与单纯辅助化疗的疗效比较

目的 比较直肠癌术后三维适形/调强放疗联合化疗与术后单纯化疗的疗效及不良反应。方法 回顾性分析直肠癌根治术患者226例,其中辅助化疗组116例,辅助放化疗组110例。辅助放化疗组采用三维适形放疗88例,调强放疗22例。剂量范围45～54 Gy,中位剂量50 Gy。全组患者化疗周期数为2～8周期,中位4周期。观察患者不良反应,比较三维适形/调强放疗联合化疗与单纯术后化疗两组不同辅助治疗模式对局部复发率、总生存率（OS）及无病生存率（DFS）的影响。结果 术后放化组1、2、3年局部复发率分别为3.8%、10.5%、10.5%,明显低于术后化疗组的15.5%、29.7%、33.2%（P=0.001）,术后放化组与术后化疗组1、2、3年OS分别为94.2%、76%、70.7%和95.6%、68.4%、53.5%,组间差异接近统计学意义（P=0.059）,1、2、3年DFS组间差异无统计学意义（P=0.608）。术后放化组的胃肠道、血液学不良反应发生率分别为78.2%和64.5%,高于术后化疗组的41.4%和30.2%（P=0.000;P=0.000）。亚组分析显示Ⅱ期患者术后放化组和术后化疗组1、2、3年OS、DFS差异均无统计学意义（P=0.810;P=0.067）。Ⅲ期患者术后放化组的1、2、3年OS高于术后化疗组,差异有统计学意义（P=0.047）,DFS与术后化疗组比较差异无统计学意义（P=0.201）。术后放化组中20.9%患者出现放射性肠炎;10%患者出现放射性膀胱炎。无3级以上不良反应发生。结论 直肠癌术后三维适形/调强放疗联合化疗可显著降低局部复发率,提高Ⅲ期直肠癌患者总生存率。放化联合治疗组血液学及胃肠道不良反应高于术后单纯化疗,但患者耐受性较好。盆腔照射采用三维适形或调强放疗技术,在提高局控率的同时可较常规放疗显著降低放射性膀胱炎和放射性肠炎的发生率和发生程度。     

Meta-analysis of postoperative adjuvant chemotherapy with tegafur-uracil in non-small-cell lung cancer.

PURPOSE: Recent clinical trials have shown the efficacy of platinum-based adjuvant chemotherapy for completely resected non-small-cell lung cancer (NSCLC). In Japan, many clinical trials of adjuvant chemotherapy with tegafur-uracil (UFT) have been conducted, and some trials showed positive results while others showed negative results. Thus, we performed a meta-analysis to assess the efficacy of postoperative adjuvant chemotherapy with UFT in NSCLC. METHODS: Among nine trials of postoperative adjuvant UFT-containing chemotherapy, six trials comparing surgery alone with surgery plus UFT were identified. Of six trials, two were three-arm trials including cisplatin-based chemotherapy followed by UFT, and data from that arm were not included in the meta-analysis. RESULTS: Of 2,003 eligible patients, most (98.8%) had squamous cell carcinoma or adenocarcinoma, and most had stage I disease; the tumor classification was T1 in 1,308 (65.3%), T2 in 674 (33.6%), and the nodal status was N0 in 1,923 (96.0%). The two treatment groups did not differ significantly in major prognostic factors. The median duration of follow-up was 6.44 years. The survival rates at 5 and 7 years were significantly higher in the surgery plus UFT group (81.5% and 76.5%, respectively) than in the surgery alone group (77.2% and 69.5%, respectively; P = .011 and .001, respectively). The overall pooled hazard ratio was 0.74, and its 95% CI was 0.61 to 0.88 (P = .001). CONCLUSION: This meta-analysis showed that postoperative adjuvant chemotherapy with UFT was associated with improved 5- and 7-year survival in a Japanese patient population composed primarily of stage I adenocarcinoma patients.     

MDR1 gene C3435T polymorphism is associated with clinical outcomes in gastric cancer patients treated with postoperative adjuvant chemotherapy

Objective: To evaluate the impact of the multi-drug resistance 1(MDR1) C3435T polymorphism on clinical outcomes in gastric cancer patients treated with postoperative adjuvant chemotherapy. Methods: From January 2005 to December 2008, 102 patients with surgically resected gastric cancers were enrolled into this study in the Affiliated Jiangsu Cancer Hospital of Nanjing Medical University. The polymorphism was tested using real time polymerase chain reaction (RT-PCR) cycling probes and the relationship with clinical outcomes after postoperative adjuvant chemotherapy was analyzed by SPSS 17.0. Results: The CT/TT genotype of C3435T was significantly associated with a shorter progression-free survival (PFS) and overall survival (OS) compared with the CC genotype [PFS: adjusted hazard ratio(HR)= 2.01, 95% confidence intervals(CI): 1.17-3.45, P = 0.012; OS: adjusted HR = 2.37, 95% CI: 1.31-4.28, P=0.004]. TNM stage was also associated with PFS (adjusted HR = 2.33, 95% CI: 1.34-4.05, P = 0.003) and OS (adjusted HR = 2.62, 95% CI: 1.44-4.76, P = 0.002) in gastric cancer patients treated with postoperative adjuvant chemotherapy. Conclusion: Our results suggest that the MDR1 gene C3435T polymorphism is associated with clinical outcomes in gastric cancer patients treated with postoperative adjuvant chemotherapy. This now needs to be confirmed by a randomized prospectively controlled study.     

Ⅰ～Ⅱ期非小细胞肺癌术后辅助化疗的Meta分析

目的应用Meta分析方法探讨术后辅助化疗对Ⅰ、Ⅱ非小细胞肺癌预后的影响。方法在MEDLINE、Highwire及中国学术期刊全文数据库（CNKI）、维普学术期刊全文数据库检索有关Ⅰ、Ⅱ期非小细胞肺癌根治术后辅助化疗的临床对照研究,分别对入选的研究进行文献评价,最后提取资料进行Meta分析。结果从1997至2007年共有16个研究入选,试验组共2048例,对照组2 046例,分析结果显示手术后行辅助化疗组与单纯手术组相比死亡风险优势比OR=0.88（95%CI0.76～1.01）,P值等于0.06,差异无统计学意义。结论Ⅰ、Ⅱ期NSCLC根治术后辅助化疗能否提高患者生存率仍不明确,需要进一步研究。     

A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma

BACKGROUND: The use of adjuvant chemotherapy to treat adults with localized resectable soft-tissue sarcoma remains controversial. The objective of this systematic review was to update the 1997 meta-analysis of randomized controlled trials (RCTs) to reassess the efficacy of doxorubicin-based chemotherapy with respect to recurrence and survival. METHODS: A comprehensive literature search was performed to identify RCTs of adjuvant chemotherapy for adult patients diagnosed with localized resectable soft-tissue sarcoma. Two reviewers independently assessed eligibility and quality of the studies using a modified version of the Detsky Quality Scale. The outcome measures were local, distant, and overall recurrence and survival calculated through the fixed effect or random effect model. RESULTS: Four new eligible trials were identified allowing for a total of 18 trials representing 1953 patients to be included in the analysis. The odds ratios (OR) for local recurrence was 0.73 (95% confidence interval [CI] 0.56-0.94; P = .02) in favor of chemotherapy. For distant and overall recurrence the OR was 0.67 (95% CI 0.56-0.82; P = .0001) in favor of chemotherapy. In terms of survival, doxorubicin alone had an OR of 0.84 (95% CI, 0.68-1.03; P = .09), which as not statistically significant. However, the OR for doxorubicin combined with ifosfamide was 0.56 (95% CI, 0.36-0.85; P = .01) in favor of chemotherapy. CONCLUSIONS: This updated meta-analysis confirms the marginal efficacy of chemotherapy in localized resectable soft-tissue sarcoma with respect to local recurrence, distant recurrence, overall recurrence, and overall survival. These benefits are further improved with the addition of ifosfamide to doxorubicin-based regimens, but must be weighed against associated toxicities.     

Survival improvement in resectable non-small cell lung cancer with (neo)adjuvant chemotherapy: results of a meta-analysis of the literature

The recent publication of many randomised trials about (neo)adjuvant chemotherapy in resectable non-small cell lung cancer (NSCLC) has prompted our group to update a prior meta-analysis of the literature. Randomised studies published in French and English between 1965 and June 2004 were included in this analysis. A qualitative assessment of each trial was first performed using the European lung cancer working party (ELCWP) and the Chalmers' scales. In absence of statistically significant quality difference between positive and negative trials, a quantitative aggregation (meta-analysis) of the individual results was performed. Two trials for which data were available on ASCO virtual meeting website were also included in the meta-analysis. Twenty-five studies eligible for this analysis assessed chemotherapy as induction (n = 6) or adjuvant to surgery (n = 19). No quality difference was detected between positive and negative trials according to the two scores, whatever all trials were combined or only adjuvant chemotherapy studies were considered. The overall meta-analysis showed that the hazard ratio (HR) of the combined results was 0.66 (95% CI 0.48-0.93) in favour of the addition of induction chemotherapy to a standard surgical procedure and 0.84 (95% CI 0.78-0.89) in favour of adjuvant chemotherapy. The effect was significant for adjuvant chemotherapy in stages I and II with a HR of 0.88 (95% CI 0.83-0.94). It was not statistically significant in stage III although the trend was in favour of chemotherapy whatever adjuvant (HR = 0.85; 95% CI 0.69-1.04) or (neo)adjuvant (HR = 0.65; 95% CI 0.41-1.04) chemotherapy was tested. In conclusion, our meta-analysis shows the efficacy of adjuvant chemotherapy in stages I and II resected NSCLC. More data are needed to confirm such a role for induction chemotherapy. Further trials should separate stage III disease from earlier stages.     

Dukes'B期结直肠癌术后辅助化疗的Meta分析

背景与目的:Dukes'B期结直肠癌根治性手术后是否需要辅助化疗,各研究报道不一,本研究利用M eta分析探讨Dukes'B期患者术后是否需要辅助化疗。方法:收集国内外1985～2003年间关于Dukes'B期结直肠癌根治性手术后给予辅助化疗的文章,将术后辅助化疗组和单纯手术组5年生存率进行综合比较。结果:符合要求纳入分析的文献共8篇,8个随机对照试验研究,累计病例6518人。比较术后化疗组和单纯手术组的5年死亡率,其合并OR值为0.79(95%CI=0.7～0.9,P<0.01),化疗组可降低术后5年死亡率。结论:Dukes蒺B期结直肠癌术后化疗可提高5年生存率。     

The impact of radiotherapy on survival in resectable gastric carcinoma: a meta-analysis of literature data

BACKGROUND: The benefit of external radiotherapy for gastric carcinoma has been extensively studied, but data on survival are still equivocal. OBJECTIVE: To assess the effectiveness of surgery combined with preoperative radiotherapy or postoperative chemoradiotherapy in the reduction of all-cause mortality in patients with resectable gastric carcinoma. METHODS: Computerised bibliographic searches of MEDLINE and CANCERLIT (1970-2006) were supplemented with hand searches of reference lists. STUDY SELECTION: Studies were included if they were randomised controlled trials (RCTs) comparing mortality of surgery combined with preoperative radiotherapy or postoperative chemoradiotherapy to surgery alone, and if they included patients with histologically-proven gastric adenocarcinoma without metastases. Nine eligible RCTs, 4 of preoperative radiotherapy (832 patients) and 5 of postoperative chemoradiotherapy (869 patients), were identified and included in the meta-analysis. DATA EXTRACTION: Data on study populations, interventions, and outcomes were extracted from each RCT according to the intention to treat method by three independent observers and combined using the DerSimonian and Laird method. RESULTS: Surgery combined with preoperative radiotherapy compared to surgery alone significantly reduced the 3-year (OR 0.57; 95% CI 0.43-0.76: p=0.0001) and 5-year (OR 0.62; 95% CI 0.46-0.84; p=0.002) mortality rate. A significant reduction of the 5-year (OR 0.45; 95% CI 0.32-0.64; p<0.00001) mortality rate was observed when surgery followed by chemoradiotherapy was compared to surgery alone. CONCLUSIONS: In patients with resectable gastric carcinoma, adjuvant radiotherapy significantly reduces 3-year and 5-year all-cause mortality, but the magnitude of the benefit is relatively small. Available evidence is inadequate to determine whether postoperative chemoradiotherapy is superior to preoperative radiotherapy.     

Significant Efficacy of Additional Concurrent Chemotherapy with Radiotherapy for Postoperative Cervical Cancer with Risk Factors a Systematic Review and Meta-analysis

Background Whether concurrent chemotherapy treatment is superior to radiotherapy alone as an adjuvant regimen for postoperative cervical carcinoma with risk factors remains controversial. Materials and Methods A literature search strategy examined Pubmed, Embase, the Cochrane Library, the China National Knowledge Internet Web, the Chinese Biomedical Database and the Wanfang Database. Article reference lists and scienti c meeting abstracts were also screened. Controlled trials comparing concurrent chemoradiotherapy versus radiotherapy alone in postoperative cervical cancer were included. The methodological quality of non- randomized controlled trials was evaluated using the Newcastle-Ottawa Scale. Randomized controlled studies were evaluated with the Cochrane handbook. A meta-analysis was performed with RevMan 5.3. Results A total of 1,073 patients from 11 clinical trials were analysed, with 582 patients in the concurrent chemoradiotherapy group and 491 patients in the radiotherapy group. Hazard ratios (HR) of 0.47 (95% CI 0.31-0.72) and 0.50 (95% CI 0.35-0.72) were observed for overall survival and progression-free survival, indicating a bene t from the additional use of concurrent chemotherapy. Subgroup analyses demonstrated that cervical cancer with high risk factors signi cantly bene tted from concurrent chemotherapy when examining overall survival (HR 0.44, 95% CI 0.28-0.67) and progression-free survival (HR 0.48, 95% CI 0.33-0.70), but patients with intermediate risk factors showed no bene t from concurrent chemotherapy in overall survival (HR 1.72, 95% CI 0.28-10.41) and progression-free survival (HR 1.09, 95% CI 0.19-6.14). No signi cant differences were observed for grade 3-4 anaemia (risk ratio (RR) 3.87, 95% CI 0.69-21.84), grade 3-4 thrombocytopenia (RR 3.04, 95% CI 0.88- 10.58), grade 3-4 vomiting or nausea (RR 1.71, 95% CI 0.27-10.96), or grade 3-4 diarrhoea (RR 1.40, 95% CI 0.69-2.83). Signi cant differences were observed for grade 3-4 neutropenia in favour of the radiotherapy group (RR 7.23, 95% CI 3.94-13.26). Conclusions In conclusion, concurrent chemoradiotherapy improves survival in postoperative cervical cancer with high risk factors but not in those with intermediate risk factors.