摘要
目的:系统评价ⅡB期宫颈癌不同治疗方式有效性及安全性。方法:计算机检索PubMed、EMBase、Medline、The Cochrane Library(2014年第12期)、CBM、CNKI、VIP与万方数据库,由2位评价者按照纳入与排除标准筛选文献、提取资料并进行质量评价后,采用RevMan5.3软件进行Meta分析。结果:共纳入21篇文献,共2 486例患者。新辅助化疗(neoadjuvant chemotherapy,NACT)组与直接根治性手术治疗(radical surgery,RS)组相比,生存率差异无统计学意义,而前者的术中出血量、手术时间、淋巴结转移率及术后并发症明显小于后者;手术综合治疗与同步放化疗比较5年生存率无区别,放射性肠炎发生率前者小于后者,放射性膀胱炎两者无差别;手术综合治疗与单纯根治性放疗相比,3年总生存率一样,但是5年总生存率前者趋向优于后者,且前者放射性肠炎发生率低于后者,瘘道形成发生率两者无区别;单纯根治性放疗与同步放化疗相比,前者胃肠道反应发生率及骨髓抑制发生率明显低于后者。结论:手术综合治疗对ⅡB期宫颈癌治疗有效,与直接手术相比,可减少术中出血量、手术时间、淋巴结转移率及术后并发症,而不良反应较放疗或同步放化疗少,有利于提高患者治疗后生活质量。
Objective：To evaluate the effectiveness and safety of different treatments in stage Ⅱ B cervical cancer.Methods：Databases including PubMed, EMBase, Medline, The Cochrane Library（Issue 12, 2014）, CBM, CNKI, VIP and Wan Fang Data were search. According to the inclusion and exclusion criteria, two reviewers identified literature, extracted data and assessed quality independently. Then meta-analysis was performed using RevMan 5.3 software. Results：Three RCTs, one prospective trials, seventeen case-control studies involving 2 486 patients were included. NACT group compared with RS group,survival has not yet found statistically significant difference, the intraoperative blood loss, operation time, lymph node metastasis rate and postoperative complications of the former is lower than the latter. The 5-years OS and the incidencerate of radioactive cystitis are not statistical differences between multimodality therapy of surgery and concurrent chemoradiation. The incidence rate of radioactive cystitis of the former is less than the latter. The multimodality therapy of surgery compared with radiotherapy, there are no statistical differences in 3-year OS and the rate of fistula formation, but the 5-year OS of the former higher than the latter,the rate of radioactive enteritis of the former is lower than the latter. The gastrointestinal reaction ′ s rate and hematological toxicity′ s rate are lower in the radiotherapy alone group than the concurrent chemoradiation group. Conclusions：The multimodality therapy of surgery treatment of stage ⅡB cervical cancer is the most effective treatment. Compared with RS, itcould reduce the intraoperative blood loss, operation time, lymph node metastasis rate and postoperative complications. Adverse reaction rate is lower than radiotherapy or concurrent chemoradiation. Therefore the multimodality therapy of surgery is more beneficial to improve the quality of life after treatment.
出处
《国际妇产科学杂志》
CAS
2016年第2期174-180,共7页
Journal of International Obstetrics and Gynecology
关键词
循证医学
META分析
宫颈肿瘤
癌
治疗
Evidence-based medicine
Meta-analysis
Uterine cervical neoplasms
Carcinoma
Therapy
