全程新辅助治疗局部进展期直肠癌疗效和安全性的Meta分析

目的 比较全程新辅助治疗(TNT)和新辅助放化疗(nCRT)治疗中低位局部进展期直肠癌的疗效和安全性.方法 全面检索中文数据库(中国知网、万方、中国生物医学文献数据库)和英文数据库(PubMed、Embase)公开发表的有关TNT和nCRT治疗局部进展期直肠癌疗效和安全性的临床研究.随机对照研究的质量评价采用Cochr...

A meta-analysis of efficacy and safety on total neoadjuvant therapy for locally advanced rectal cancer

Objective To evaluate the efficacy and safety of total neoadjuvant therapy for locally advanced rectal cancer.Methods A systemic search of CNKI,Wan Fang,CBM,Pub Med and Embase was conducted for the studies that compared the efficacy of TNT and n CRT for rectal cancer.The quality evaluation of randomized controlled trials was based on the Cochrane’s risk of bias tool,while nonrandomized trials were assessed using Newcastle-Ottawa Scale.Rev Man 5.3 software was used for metaanalisis,and the rate of p CR,T-downstaging,R0 resection and sphincter preservation rate,grade 3/4 acute toxicity during treatment,perioperative complications and survival benefits were compared between the two groups.Results A total of 14 studies was included with the amount of 3797 patients,1865 and 1932 in TNT group and n CRT group respectively.Meta analysis revealed that,a significant difference existed in the rate of p CR(OR=1.57,95%CI:1.30~1.90,P<0.00001),T-downstaging(OR=2.16,95%CI:1.63~2.57,P<0.00001)and R0 resection(OR=1.42,95%CI:1.09~1.85,P=0.009).There was no significant difference in the rate of perioperative complication and acute toxicity between the two groups.The 5-OS and 5-DFS werecomparable between TNT group and n CRT group,indicating that TNT showed no survival benefits on rectal cancer patients.Conclusion Compared to n CRT,though no significant improvement in OS and DFS,the rate of pCR,tumor downstaging and R0 resection rate was improved in TNT group.