食管癌新辅助放化疗结合手术与单纯手术治疗随机对照试验的Meta分析.DOCVIP

临床医学论文-食管癌新辅助放化疗结合手术与单纯手术治疗随机对照试验的Meta分析 【摘要】? ［目的］ 评价新辅助放化疗（CRTS组）与单纯手术（S组）治疗食管癌的疗效与安全性。［方法］ 检索Cochrane图书馆、PubMed，OVID数据库和中国期刊网中的食管癌英文和中文随机对照试验(RCT)文献，将Jadad积分≥3分高质量文章纳入研究。数据分析采用Revman 4.2软件，检验异质性，并根据异质性结果选择相应的效应模型。绘制漏斗图评定有无发表偏倚。［结果］ 共8项RCT，1 110例食管癌患者入选。与单纯手术组（S组）比较，新辅助放化疗治疗（CRTS组）明显延长食管癌患者1年、3年生存率，OR分别为1.33（95％CI：1.03~1.72，P＝0.03），1.62（95％CI：1.19~2.20，P＝0.002）；术后并发症的合并优势比为1.41（95％CI：0.83~2.41，P＝0.20）。［结论］ 与单纯手术相比，新辅助放化疗能明显延长食管癌患者的1年、3年生存率，但不能降低手术后并发症的发生率。 【关键词】? 食管肿瘤 新辅助疗法 外科学 Meta分析 ??? A Meta-Analysis of Randomized Clinical Trials (RCTs) that Compared? Chemoradiotherapy Followed by Surgery to Surgery alone for Oesophageal Cancer ???? Abstract: ［Purpose］ To evaluate the efficacy and safety of chemoradiotherapy followed by surgery (CRTS group) and surgery alone (S group) for oesophageal cancer. ［Methods］ Esophageal cancer in Chinese and English published RCTs were searched from Cochrance library, pubmed and CBM. RCTs were considered high quality if methodological quality score was 3 or more according Jadad standard. Statistical heterogeneity among these RCTs was evaluated by Revman 4.2. Heterogeneity of the included RCTs was tested, which was used to select proper effect model to calculate. Publication bias was investigated through visual inspection of funnel plots. ［Results］ Eight RCTs included 1110 cases with esophageal cancer were selected. Compared with S group, CRTS group significantly increased 1-year, 3-year survival rate of esophageal cancer. The odds ratio (OR) was 1.33（95％CI: 1.03~1.72，P＝0.03） for 1-year survival，1.62（95％CI: 1.19~2.20，P＝0.002） for 3-year survival, and the total OR of postoperative complication in CRTS group was 1.41（95％CI: 0.83~2.41，P＝0.20）. Inspection of the funnel plots for all outcome measures did not reveal evidence of publication bias. ［Conclusion］ Compared with surgery alone, neoadjuvant chemoradiation and surgery improves 1-year, 3-year survival rate of esophageal cancer, but doesn’t reduce the postoperative complication. ??? Ke