摘要
目的系统评价Ⅲ期结直肠癌患者首次术后化疗(PAC)的最佳时间间隔点,并探讨术后并发症对间隔点的影响。方法检索Cochrane Library,PubMed,Web of Sience,China National Knowledge Internet(CNKI)数据库。用森林图法系统性分析不同时间起始PAC与Ⅲ期结直肠癌患者临床预后的关联,统计相关的总体存活率(OS),无复发存活率(RFS),并讨论术后并发症对首次PAC时间间隔的影响。结果共11篇文献纳入研究,总计47 775例患者(男26 499例;女21 276例)。发现以8周为分界,PAC时间间隔>8周时OS明显下降(OR=1.75,95%CI=1.35-2.25,P<0.01)。以不同的PAC时间间隔为界,OS同样会随着PAC的延长而明显下降(OR=1.55,95%CI=1.23~1.93,P=0.01),但RFS不会随之下降(P=0.10)。术后并发症成为起始PAC延期的关键因素之一(OR=2.45,95%CI=1.19~5.01,P=0.01)。结论Ⅲ期结直肠癌患者术后首次PAC应在8周内进行。延期PAC会导致不良的OS,而对RFS没有明显影响。对于术后并发症的良好控制,是保证PAC按时进行的必要条件。
Objective To gain access to the suitable interval of postoperative adjuvant chemotherapy(PAC)for stageⅢcolorectal cancer patients by meta-analysis and identify the effects of postoperative complications on interval as well.Methods Case-control studies assessing the interval time between curative resection surgery and first PAC forⅢCRC patients were identified from Cochrane Library,PubMed,Web of Science,China National Knowledge Internet(CNKI).Overall Survival(OR),Relapse-Free Survival(RFS),as well as the associations between postoperative complications and interval were concluded and statistically analyzed by Forest Plot.Results Eleven case-control studies which covered a total of 47 775 patients(26 499 males;21 276 females)were contained in this meta-analysis.We chose eight weeks for the cut-off,beyond which was related to worse OS(OR=1.75;95%CI=1.35-2.25,P<0.01).If a variety of cut-offs were included,longer delay was similarly associated to a worse OS(OR=1.55,95%CI=1.23-1.93,P=0.0001),but not a worse RFS(P=0.10).Postoperative complications became a key point of the delays of PAC(OR=2.43,95%CI=1.19-4.96,P=0.01).Conclusion The first PAC should be performed within eight weeks in patients with stageⅢcolorectal cancer.Delayed PAC results in poor OS,while RFS has no significant impact.Effective control of postoperative complications is a necessary factor to ensure PAC on schedule.
作者
肖刘牛
陈颖铭
冯永东
Xiao Liuniu;Chen Yingming(Department of Gastrointestinal Surgery,Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430014,China)
出处
《临床荟萃》
CAS
2018年第4期342-348,共7页
Clinical Focus
关键词
结直肠肿瘤
手术后并发症
放化疗
辅助
预后
colorectal neoplasm
postoperative complications
adjuvant chemoradiotherapy
prognosis
