TP与FP方案治疗晚期食管癌的疗效与安全性的Meta分析

目的系统评价比较紫杉醇联合顺铂(TP方案)与5-氟尿嘧啶联合顺铂(FP方案)治疗晚期食管癌的疗效及不良反应。方法计算机及手工检索相关文献,纳入比较TP与FP方案治疗晚期食管癌的随机对照试验进行系统评价。结果共有4个随机对照实验符合纳入标准,共计240例晚期食管癌患者。纳入研究普遍质量较低,大多只对近期疗效进行研究,缺乏对远期疗效的评估。Meta分析显示:TP方案完全缓解率[=0.44,I2=0%,RR=2.93,95%CI(1.05,8.21),P=0.04]及有效率[=0.88,I2=0%,RR=1.78,95%CI(1.38,2.28),P<0.01]均明显高于FP方案,有统计学意义;但TP组重度骨髓抑制(白细胞减少)、严重脱发、严重关节肌肉痛等不良反应的发生率明显高于FP组(P<0.05)。结论本系统评价纳入研究均为中文文献,数量较少,质量普遍较低,且缺少对远期疗效的评估。虽目前研究提示TP方案治疗晚期食管癌疗效优于FP方案,但尚需更多高质量的多中心临床随机对照试验进一步验证。同时在临床工作中,TP方案易导致的严重不良反应如骨髓抑制等,也值得警惕。

The comparisonof paclitaxel plus cisplatin with 5-Fluorouracil plus cisplatin for the treatment of advanced esophageal cancer:a Meta-analysis

Objective To compare the efficacy and safety of 2 kinds of chemotherapies using paclitaxel-cisplatin and 5-fluorouracil-cisplatin respectively in treatment of advanced esophageal cancer.Methods We searched out all the randomized controlled trials confirmed to treat advanced esophageal cancer with paclitaxel-cisplatin and 5-fluorouracil-cisplatin,and performed a meta-analysis.Results A total of 4 trials involving 240 patients with advanced esophageal cancer were included.All trials only assessed the short-term efficacy of the 2 kinds of chemotherapies,and most had high risk of bias.The results of meta-analysis showed that the complete remission rate [=0.44,I2=0%,RR=2.93,95%CI(1.05,8.21),P=0.04] and response rate [=0.88,I2=0%,RR=1.78,95%CI(1.38,2.28),P<0.01] of paclitaxel-cisplatin groups were significantly higher than 5-fluorouracil-cisplatin groups;However,the incidence of some severe toxicity such as myelosuppression,alopecia,arthralgia and myalgia in paclitaxel-cisplatin groups was significantly higher than 5-fluorouracil-cisplatin groups.Conclusion The present studies showed that paclitaxel-cisplatin was more effective than 5-fluorouracil-cisplatin for advanced esophageal cancer,but likely apt to suffer from severe toxicity such as myelosuppression.Multi-factors such as low-quality and small amount of included studies which lead to bias affected the authenticity of our review,so further large-scale trials are required.