基于Meta分析同步放化疗比单纯放疗治疗晚期鼻咽癌更有效
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摘要
为了探讨同步放化疗与单纯放疗应用于晚期鼻咽癌的疗效,本研究按照有关纳入标准检索Cochrane图书馆、中国生物医学文献光盘数据库以及MEDLINE光盘数据库临床对照试验资料库以及练级检索SCI数据库等的文献,应用Rev Man软件进行Meta分析。共纳入10个临床研究的1 200例患者进行研究,比较同步放化疗和单纯放化疗在晚期鼻咽癌中的治疗中生存率和远处转移率。同步放化疗组和单纯放化疗组3年、5年生存率分别为:67.33%和47.33%、51.91%和41.22%;同步放化疗组比单纯放疗组患者的3年和5年生存率分别提高了12.1%和11%。同步放化疗和单纯放化疗远处转移率分别为:26.19%、38.71%;同步放化疗组比单纯放疗组远处转移率下降了12%。同步放化疗比单纯放化疗组更能提高晚期鼻咽癌患者的生存率,降低远处转移率。
In order to investigate efficacy of concurrent chemoradiotherapy and pure radiation therapy in advanced nasopharyngeal carcinoma radiotherapy, we selected the followed electronic databases: the Cochrane library, the Chinese biomedical literature CD database and MEDLINE cd-rom databases controlled clinical trials database and leveling retrieval SCI database, according to the inclusion criteria. Using Rev Man software made a meta-analysis. 10 clinical studies of 1 200 patients were included in the study, comparing the chemoradiation and pure radiation and chemotherapy in the treatment of advanced nasopharyngeal carcinoma survival rate and distant metastasis rate. The survival rate of concurrent chemoradiotherapy group 3-year, 5-year were 67.33%, 47.33%, and pure radiation therapy group 3-years, 5-years were: were 51.91%, 41.22%, respectively. The survival rate of concurrent chemoradiotherapy group 3-year, 5-year were increased by 12%, 11% than simple radiotherapy, respectively. The distant metastasis rate of concurrent chemoradiation, radiation alone were 26.19%, 38.71%, respectively; the distant metastasis rate of concurrent chemoradiotherapy group was decreased by 12% thanradiotherapy alone. The concurrent chemoradiation is better than pure chemoradiotherapy group to improe surial in patients with advanced nasopharyngeal carcinoma, and reduce the rate of distant metastasis.
In order to investigate efficacy of concurrent chemoradiotherapy and pure radiation therapy in advanced nasopharyngeal carcinoma radiotherapy, we selected the followed electronic databases: the Cochrane library, the Chinese biomedical literature CD database and MEDLINE cd-rom databases controlled clinical trials database and leveling retrieval SCI database, according to the inclusion criteria. Using Rev Man software made a meta-analysis. 10 clinical studies of 1 200 patients were included in the study, comparing the chemoradiation and pure radiation and chemotherapy in the treatment of advanced nasopharyngeal carcinoma survival rate and distant metastasis rate. The survival rate of concurrent chemoradiotherapy group 3-year, 5-year were 67.33%, 47.33%, and pure radiation therapy group 3-years, 5-years were: were 51.91%, 41.22%, respectively. The survival rate of concurrent chemoradiotherapy group 3-year, 5-year were increased by 12%, 11% than simple radiotherapy, respectively. The distant metastasis rate of concurrent chemoradiation, radiation alone were 26.19%, 38.71%, respectively; the distant metastasis rate of concurrent chemoradiotherapy group was decreased by 12% thanradiotherapy alone. The concurrent chemoradiation is better than pure chemoradiotherapy group to improe surial in patients with advanced nasopharyngeal carcinoma, and reduce the rate of distant metastasis.
引文
Bao R.K.,2014,Systemic evaluation on the therapeautic effect of concurrent chemoradiation in the treatment of lacally advanced nasopharyngeal carcinoma-a meta-analysis of the phaseⅢrandomized controlled trials,Thesis for M.S.,Suzhou University,Supervisor:Shen Y.P.,pp.1-48(包睿康,2014,同步放化疗对局部晚期鼻咽癌的系统性疗效评估--一项基于Ⅲ期临床试验Meta分析,硕士学位论文,苏州大学,导师:沈月平,pp.1-48)
Baujat B.,Audry H.,Bourhis J.,Chan A.T.,Onat H.,Chua D.T.,Kwong D.L.,Al-Sarraf M.,Chi K.H.,Hareyama M.,Leung S.F.,Thephamongkhol K.,Pignon J.P.,and MAC-NPC Collaborative Group,2006,Chemothe alpy in locally advanced nasopharyngea I cainoma:an individual patient data metaanalysis of eight domized trials a Ild 1753 patients,Int.J.Radiat.Oncol.Biol.Phys.,64(1):47-56
Chan A.T.,Leung S.F.,and Ngan R.K.,2005,Overall survival after concun'ent cisplatin-mdiotherapv compared with radiotherapv alone in locoregiona Uy advanced nasopharyngeal carcinoma,J.Natl.Cancer Inst.,97(7):536-539
Chen C.B.,Pan J.J.,Lin S.J.,Zheng W.,and Chen M.,2006,Clinical study of irradiation combined with late course chemotherapy in nasopharyngeal carcinoma,Zhonghua Zhongliu Fangzhi Zazhi(Chinese Journal of Cancer Prevention and Treatment),13(12):935-936(陈传本,潘建基,林少俊,郑葳,陈梅,2006,鼻咽癌放疗后程配合化疗临床研究,中国肿瘤防治杂志,13(12):935-936)
Chen C.Y.,Lu T.X.,Zhao C.,Sun Y.,Lu L.X.,Han F.,and Liu X.F.,2006,Radiotherapy alone for T3~T4N0~N3 nasopharyngeal carcinoma,Zhonghua Fangshe Zhongliuxue Zazhi(Chinese Journal of Radiation Oncology),2(15):77-80(陈春燕,卢泰祥,赵充,孙颖,卢丽霞,韩非,刘秀芳,2006,T3~T4N0~N3期鼻咽癌单纯放疗疗效分析,中华放射肿瘤学杂志,2(15):77-80)
Du M.J.,and Li G.S.,2009,Concurrent Chemoradiotherapy for 40cases with locally advanced nasopharyngeal carcinoma,Zhongliuxue Zazhi(Journal of Oncology),15(5):388-390(杜敏娟,李桂生,2009,同步放化疗治疗局部晚期鼻咽癌40例,肿瘤学杂志,15(5):388-390)
Feng F.Y.,2003,Nasopharyngeal carcinoma,In:Zhou J.C.(ed),Practical internal medicine tumor,People's medical publishing house,Beijing,China,pp.644-649(冯奉仪,2003,鼻咽癌,见:周际昌(编著),实用肿瘤内科学,人民卫生出版社,中国,北京,pp.644-649)
Fu J.Z.,Li J.G.,Gong X.C.,Dong J.L.,and Ao F.,2009,Prospective clinical study comparing standard radiotherapy with or without low dose cisplatin used concurrently twice a week in treatment of locoregionally advanced nasopharyngeal carci noma,Shiyong Aizheng Zazhi(Practical Journal of Cancer),24(2):180-183(傅敬忠,李金高,龚晓昌,董俊林,敖帆,2009,局部晚期鼻咽癌每周两次小剂量顺铂同期放化疗临床研究,实用癌症杂志,24(2):180-183)
Kwong D.L.,Sham J.S.,Au G.K.,Chua D.T.,Kwong P.W.,Cheng A.C.,Wu P.M.,Law M.W.,Kwok C.C.,Yau C.C.,Wan K.Y.,Chan R.T.,and Choy D.D.,2004,Concurrent and adjuvant Chemotherapy for Nasopharyngeal carcinoma:a factorial study,J.Clin.Oncol.,22(13):2643-2653
Langendijk J.A.,Leemans C.R.,Buter J.,Berkhof J.,and Slotman B.J.,2004,The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma:a meta-analysis of the published literature,J.Clin.Oncol.,22(22):4604-4612
Lee A.W.,Tung S.Y.,Chua D.T.,Ngan R.K.,Chappell R.,Tung R.,Siu L.,Ng W.T.,Sze W.K.,Au G.K.,Law S.C.,O'Sullivan B.,Yau T.K.,Lrung T.W.,Au J.S.,Sze W.M.,Choi C.W.,Fung K.K.,Lau J.T.,and Lau W.H.,2010,Randomized trial of adiotherapy plus concurrent-adjuvant chemotherapy vs adiotherapy alone for regionally advanced nasopharyngeal carcinoma,J.Natl.Cancer Inst.,102(15):1188-1198
Lin J.C.,Liang W.M.,Jan J.S.,Jiang R.S.,and Lin A.C.,2004,Anotller way to estimate outcome of advanced nasopharyngeal carcinoma-is concurrent chemoradiotherapy adequate,Int.J.Radiat.Oncol.Biol.Phys.,60(1):156-164
Liu L.Q.,and Zhang X.Z.,2003,Adjuvant chemotherapy in nasopharyngeal carcinoma patients with high risk of metasta sis,Shiyong Aizheng Zazhi(The Practical Journal of Cancer),18(4):394-396(刘丽琴,张西志,2003,辅助化疗对高危远处转移鼻咽癌患者生存率的影响,实用癌症杂志,18(4):394-396)
Xuan Y.,2013,Chemoradiation in the treatment of locally advanced nasopharyngeal carcinoma of Meta-analysis,Thesis for M.S.,China medical university,Supervisor:Wu R.,pp.204-208(宣莹,2013,同步放化疗治疗局部晚期鼻咽癌的Meta分析,硕士学位论文,中国医科大学,导师:吴荣,pp.204-208)
Xuan Y.,Zhang Z.Y.,Zeng Y.C.,and Wu R.,2013,Meta-analysis of concurrent chemoradiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma,Zhongguo Yike Daxue Xuebao(Journal of China Medical University),42(3):204-208(宣莹,张振勇,曾越灿,吴荣,2013,同步放化疗治疗局部晚期鼻咽癌的Meta分析,中国医科大学学报,42(3):204-208)
Yang A.K.,Liu T.R.,Guo X.,Qi G.L.,Chen F.J.,Guo Z.M.,Zhang Q.,Zeng Z.Y.,Chen W.C.,and Li Q.L.,2008,Concurrent chemoradiotherapy versus radiotherapy alone for locoregionally advanced nasopharyngeal carclnoma:a Metaanalysis,Zhonghua Erbiyanhoutoujing Waike Zazhi(Chinese Journal of Otolaryngology Head and Neck Surgery),43(3):218-223(杨安奎,刘天润,郭翔,齐国隆,陈福进,郭朱明,张诠,曾宗渊,陈伟超,李秋梨,2008,同步放化疗与单纯放疗在晚期鼻咽癌中疗效比较的Meta分析,中华耳鼻咽喉头颈外科杂志,43(3):218-223)
Zhang A.M.,2009,Adding chemotherapy to radiotherapy for nasopharyngeal cancer:a meta-analysis of randomized controlled trial,Thesis for M.S.,The Third Military Medical U-niversity,Supervisor:Chen Z.T.,pp.1-61(张岸梅,2009,放化疗结合治疗局部晚期鼻咽癌疗效的Meta分析,硕士学位论文,第三军医大学,导师:陈正堂,pp.1-61)
Zhang L.,Zhao C.,Peng P.J.,Lu L.X.,Huang P.Y.,Han F.,and Wu S.X.,2005,PhaseⅢstudy comparing standard radiotherapy t11 or without weekly Oxaliplatin in treatment of locoregionally advanced nasopharyngeal carcinoma:preliminary results,J.Clin.Oncol.,23(33):846l-8468
Zhao J.,2012,Cisplatin and paclitaxel chemoradiation for locally advanced nasopharyngeal carcinoma curative effect of Metaanalysis,Thesis for M.S.,Guangdong Medical College,Supervisor:Yu Z.H.,pp.1-77(赵珺,2012,顺铂和紫杉醇同步放化疗对局部晚期鼻咽癌疗效的Meta分析,硕士学位,广东医学院,导师:余忠华,pp.1-77)
Zhu L.C.,and Zou C.L.,2013,Radiotherapy combined with EGFR antibody versus radiotherapy alone in advanced nasopharyngeal carcinoma:a meta-analysis,Wenzhou Yixueyuan Xuebao(Journal of Wenzhou Medical College),43(9):626-629(朱鲁程,邹长林,2013,EGFR单抗联合放疗与单纯放疗在中晚期鼻咽癌中疗效比较的Meta分析,温州医学院学报,43(9):626-629)
Baujat B.,Audry H.,Bourhis J.,Chan A.T.,Onat H.,Chua D.T.,Kwong D.L.,Al-Sarraf M.,Chi K.H.,Hareyama M.,Leung S.F.,Thephamongkhol K.,Pignon J.P.,and MAC-NPC Collaborative Group,2006,Chemothe alpy in locally advanced nasopharyngea I cainoma:an individual patient data metaanalysis of eight domized trials a Ild 1753 patients,Int.J.Radiat.Oncol.Biol.Phys.,64(1):47-56
Chan A.T.,Leung S.F.,and Ngan R.K.,2005,Overall survival after concun'ent cisplatin-mdiotherapv compared with radiotherapv alone in locoregiona Uy advanced nasopharyngeal carcinoma,J.Natl.Cancer Inst.,97(7):536-539
Chen C.B.,Pan J.J.,Lin S.J.,Zheng W.,and Chen M.,2006,Clinical study of irradiation combined with late course chemotherapy in nasopharyngeal carcinoma,Zhonghua Zhongliu Fangzhi Zazhi(Chinese Journal of Cancer Prevention and Treatment),13(12):935-936(陈传本,潘建基,林少俊,郑葳,陈梅,2006,鼻咽癌放疗后程配合化疗临床研究,中国肿瘤防治杂志,13(12):935-936)
Chen C.Y.,Lu T.X.,Zhao C.,Sun Y.,Lu L.X.,Han F.,and Liu X.F.,2006,Radiotherapy alone for T3~T4N0~N3 nasopharyngeal carcinoma,Zhonghua Fangshe Zhongliuxue Zazhi(Chinese Journal of Radiation Oncology),2(15):77-80(陈春燕,卢泰祥,赵充,孙颖,卢丽霞,韩非,刘秀芳,2006,T3~T4N0~N3期鼻咽癌单纯放疗疗效分析,中华放射肿瘤学杂志,2(15):77-80)
Du M.J.,and Li G.S.,2009,Concurrent Chemoradiotherapy for 40cases with locally advanced nasopharyngeal carcinoma,Zhongliuxue Zazhi(Journal of Oncology),15(5):388-390(杜敏娟,李桂生,2009,同步放化疗治疗局部晚期鼻咽癌40例,肿瘤学杂志,15(5):388-390)
Feng F.Y.,2003,Nasopharyngeal carcinoma,In:Zhou J.C.(ed),Practical internal medicine tumor,People's medical publishing house,Beijing,China,pp.644-649(冯奉仪,2003,鼻咽癌,见:周际昌(编著),实用肿瘤内科学,人民卫生出版社,中国,北京,pp.644-649)
Fu J.Z.,Li J.G.,Gong X.C.,Dong J.L.,and Ao F.,2009,Prospective clinical study comparing standard radiotherapy with or without low dose cisplatin used concurrently twice a week in treatment of locoregionally advanced nasopharyngeal carci noma,Shiyong Aizheng Zazhi(Practical Journal of Cancer),24(2):180-183(傅敬忠,李金高,龚晓昌,董俊林,敖帆,2009,局部晚期鼻咽癌每周两次小剂量顺铂同期放化疗临床研究,实用癌症杂志,24(2):180-183)
Kwong D.L.,Sham J.S.,Au G.K.,Chua D.T.,Kwong P.W.,Cheng A.C.,Wu P.M.,Law M.W.,Kwok C.C.,Yau C.C.,Wan K.Y.,Chan R.T.,and Choy D.D.,2004,Concurrent and adjuvant Chemotherapy for Nasopharyngeal carcinoma:a factorial study,J.Clin.Oncol.,22(13):2643-2653
Langendijk J.A.,Leemans C.R.,Buter J.,Berkhof J.,and Slotman B.J.,2004,The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma:a meta-analysis of the published literature,J.Clin.Oncol.,22(22):4604-4612
Lee A.W.,Tung S.Y.,Chua D.T.,Ngan R.K.,Chappell R.,Tung R.,Siu L.,Ng W.T.,Sze W.K.,Au G.K.,Law S.C.,O'Sullivan B.,Yau T.K.,Lrung T.W.,Au J.S.,Sze W.M.,Choi C.W.,Fung K.K.,Lau J.T.,and Lau W.H.,2010,Randomized trial of adiotherapy plus concurrent-adjuvant chemotherapy vs adiotherapy alone for regionally advanced nasopharyngeal carcinoma,J.Natl.Cancer Inst.,102(15):1188-1198
Lin J.C.,Liang W.M.,Jan J.S.,Jiang R.S.,and Lin A.C.,2004,Anotller way to estimate outcome of advanced nasopharyngeal carcinoma-is concurrent chemoradiotherapy adequate,Int.J.Radiat.Oncol.Biol.Phys.,60(1):156-164
Liu L.Q.,and Zhang X.Z.,2003,Adjuvant chemotherapy in nasopharyngeal carcinoma patients with high risk of metasta sis,Shiyong Aizheng Zazhi(The Practical Journal of Cancer),18(4):394-396(刘丽琴,张西志,2003,辅助化疗对高危远处转移鼻咽癌患者生存率的影响,实用癌症杂志,18(4):394-396)
Xuan Y.,2013,Chemoradiation in the treatment of locally advanced nasopharyngeal carcinoma of Meta-analysis,Thesis for M.S.,China medical university,Supervisor:Wu R.,pp.204-208(宣莹,2013,同步放化疗治疗局部晚期鼻咽癌的Meta分析,硕士学位论文,中国医科大学,导师:吴荣,pp.204-208)
Xuan Y.,Zhang Z.Y.,Zeng Y.C.,and Wu R.,2013,Meta-analysis of concurrent chemoradiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma,Zhongguo Yike Daxue Xuebao(Journal of China Medical University),42(3):204-208(宣莹,张振勇,曾越灿,吴荣,2013,同步放化疗治疗局部晚期鼻咽癌的Meta分析,中国医科大学学报,42(3):204-208)
Yang A.K.,Liu T.R.,Guo X.,Qi G.L.,Chen F.J.,Guo Z.M.,Zhang Q.,Zeng Z.Y.,Chen W.C.,and Li Q.L.,2008,Concurrent chemoradiotherapy versus radiotherapy alone for locoregionally advanced nasopharyngeal carclnoma:a Metaanalysis,Zhonghua Erbiyanhoutoujing Waike Zazhi(Chinese Journal of Otolaryngology Head and Neck Surgery),43(3):218-223(杨安奎,刘天润,郭翔,齐国隆,陈福进,郭朱明,张诠,曾宗渊,陈伟超,李秋梨,2008,同步放化疗与单纯放疗在晚期鼻咽癌中疗效比较的Meta分析,中华耳鼻咽喉头颈外科杂志,43(3):218-223)
Zhang A.M.,2009,Adding chemotherapy to radiotherapy for nasopharyngeal cancer:a meta-analysis of randomized controlled trial,Thesis for M.S.,The Third Military Medical U-niversity,Supervisor:Chen Z.T.,pp.1-61(张岸梅,2009,放化疗结合治疗局部晚期鼻咽癌疗效的Meta分析,硕士学位论文,第三军医大学,导师:陈正堂,pp.1-61)
Zhang L.,Zhao C.,Peng P.J.,Lu L.X.,Huang P.Y.,Han F.,and Wu S.X.,2005,PhaseⅢstudy comparing standard radiotherapy t11 or without weekly Oxaliplatin in treatment of locoregionally advanced nasopharyngeal carcinoma:preliminary results,J.Clin.Oncol.,23(33):846l-8468
Zhao J.,2012,Cisplatin and paclitaxel chemoradiation for locally advanced nasopharyngeal carcinoma curative effect of Metaanalysis,Thesis for M.S.,Guangdong Medical College,Supervisor:Yu Z.H.,pp.1-77(赵珺,2012,顺铂和紫杉醇同步放化疗对局部晚期鼻咽癌疗效的Meta分析,硕士学位,广东医学院,导师:余忠华,pp.1-77)
Zhu L.C.,and Zou C.L.,2013,Radiotherapy combined with EGFR antibody versus radiotherapy alone in advanced nasopharyngeal carcinoma:a meta-analysis,Wenzhou Yixueyuan Xuebao(Journal of Wenzhou Medical College),43(9):626-629(朱鲁程,邹长林,2013,EGFR单抗联合放疗与单纯放疗在中晚期鼻咽癌中疗效比较的Meta分析,温州医学院学报,43(9):626-629)