儿童髓母细胞瘤的化疗疗效及预后因素的系统评价

目的:系统评价儿童髓母细胞瘤的疗效及预后因素。方法:计算机检索国内外5个最大的医学数据库,收集国内外与儿童髓母细胞瘤化疗有关的临床随机对照试验文献,进行质量学评价。Meta分析采用RevMan4.2.8软件。结果:共纳入了4篇临床随机对照试验文献。Meta分析结果显示:化疗可以提高儿童髓母细胞瘤的5年无事件生存率(EFS)RR=1.21,95%CI(1.06,1.38),P<0.01]。高危患者化疗的5年EFS优于不化疗者RR=1.92,95%CI(1.33～2.78),P<0.01]。化疗对儿童髓母细胞瘤的5年总生存率(OS)与不化疗者无明显差异RR=1.08,95%CI(0.95～1.23),P>0.05]。肿瘤非全切者的5年EFS低于全切者OR=0.66,95%CI(0.47～0.93),P<0.05];低级别肿瘤(T1、T2期)的5年EFS高于高级别肿瘤(T3、T4期)OR=2.08,95%CI(1.47～2.94),P<0.01]。低年龄组的5年EFS显著低于高年龄组RR=0.67,95%CI(0.49～0.90),P<0.01]。结论:儿童髓母细胞瘤的综合治疗加化疗可以提高其EFS,推迟肿瘤的复发,特别是对高危患者。化疗对总生存率的影响不大。肿瘤不全切除、较高T分期和低年龄患者都是显著降低患者5年生存率的因素。

A systematic review for the treatment of childhood medulloblastoma pre-radiation chemotherapy versus radiotherapy alone

Objective:To assess systematically the the outcome of therapies and the prognostic factors for childhood medullublastoma.Methods:We searched the largest medical literature data base in the world on line,and looked up the relevant Chinese and English neurosurgical journals.Randomized controlled trials and clinical controlled trials of chemotherapy for childhood medulloblastoma were included.The quality of trials were critically assessed.RevMan 4.2.8 software was used for Meta analysis.Results:Four RCTs of pre-radiation chemotherapy versus radiotherapy for childhood medulloblastoma were included.The results of meta-analysis showed that pre-radiation chemotherapy for childhood medullublastoma increased the event-free survival RR=1.21,95% CI(1.06,1.38) P=0.004].More advantage of event-free survival achieved for children with advanced stages disease treated in radiotherapy plus chemotherapy group.The difference of overall survival failed to show statistically significant between two protocols RR=1.08,95% CI(0.95,1.23) P=0.24].Prognostic factors:The event-free survival rates between patients who had gross complete removal of tumor versus less complete ones were significant difference OR=0.66,95%CI(0.47,0.93) P=0.02].The T-stage of tumor T1-2 Vs T3-4 and younger age Vs older age were significant difference achieved OR=2.08,95% CI(1.47,2.94) P=0.0001] And RR=0.67 95% CI(0.49,0.90) P=0.009].Conclusions:Compared with radiotherapy alone the pre-radiation chemotherapy increased event-free survival rates for childhood medulloblastoma especially for children with advanced stages disease.The difference of overall survival failed to show statistically significant between two protocols.The prognostic factors may be extent of surgical resection,patient's age and the T-stage of tumor.