直肠癌新辅助治疗有效性与安全性的Meta分析

目的系统评价新辅助治疗在直肠癌中的治疗作用及其对术后并发症的影响。方法检索2010年5月前在PubMed．Ovid，WebofScience，Springer-Link，ElsevierScienceDirect等数据库已公开发表的比较直肠癌新辅助治疗与单纯手术或术后辅助治疗的随机对照试验（RCT），并进行入选标准和质量评价．对符合标准的文献提取相关临床效应指标进行Meta分析。结果11篇RCT共7407例患者纳入分析．新辅助治疗组3685例，对照组为3722例。直肠癌新辅助治疗组局部复发率（OR=O．43，95％CI：0．37-0．50，P〈0．01）、远处转移率（OR=0．85，95％CI：0．76-0．95，P〈0．01）、5年生存率（RR=1．15，95％CI：1．04-1．28，P〈0．01）及保肛手术率（RR=I．48，95％CI：1．17-1．87，P〈0．01）均优于对照组，差异有统计学意义，但术后死亡率（DR=1．20，95％CI：0．68-2．13，P=0．53）及吻合口并发症发生率（OR=1．04,95％CI：0．73-1．48，P=0．84）的差异无统计学意义。结论直肠癌新辅助治疗有利于控制局部及远处复发．提高远期生存，未明显增加术后并发症的发生率。

Meta-analysis of efficacy and safety on neoadjuvant therapy for rectal cancer

Objective To assess the value of neoadjuvant therapy for resectable rectal cancer and the impact on postoperative complications. Methods Literature search was performed in PubMed, Ovid, Web of Science, Springer-Link and Elsevier ScienceDirect for randomized controlled trials published before May 2010 that compared neoadjuvant therapy with surgery alone or postoperative adjuvant therapy. The computer search was supplemented with hand search of reference lists for available primary studies. Inclusion criteria and quality assessment were performed. Results Eleven studies including 7407 patients were enrolled for analysis. Neoadjuvant therapy group had significant advantages in local recurrence （OR=0.43, 95%CI：0.37-0.50, P〈0.01）, distant recurrence （OR=0.85, 95%CI：0.76-0.95, P=〈0.01）, 5-year overall survival （RR=1.15, 95%CI：1.04-1.28, P〈0.01）, and sphincter-saving surgery （RR=1.48, 95%CI： 1.17-1.87, P〈0.01）. There were no significant difference in postoperative mortality rate （OR = 1.20, 95% CI： 0.68-2.13, P=0.53） and anastomotic complications （OR=1.04, 95%CI：0.73-1.48, P=0.84）. Conclusion Neoadjuvant therapy improves local control, distant recurrence and long-term survival without increasing postoperative complications.