摘要
目的 探讨食管癌最佳的新辅助治疗策略,为临床制定食管癌新辅助治疗方案提供理论基础。方法 检索PubMed、EMbase、The Cochrane Library、Web of Science、中国知网、万方、维普,检索时限均为建库至2022年5月,由2名研究人员独立进行文献筛选、数据提取。采用Cochrane偏倚风险评价工具对文献质量进行评价,在RStudio环境下使用R3.6.3软件进行数据分析。结果 共纳入24项研究,包括5 286例患者,治疗方法分别为单独接受手术治疗,新辅助化疗(neoadjuvant chemotherapy,NCT)、新辅助放疗(neoadjuvant radiotherapy,NRT)或新辅助放化疗(neoadjuvant chemoradiotherapy,NCRT)后联合手术治疗。纳入文献的偏倚风险较低。网状Meta分析结果显示,与单纯手术相比,NCRT[HR=0.77,95%CI(0.70,0.85)]和NCT[HR=0.89,95%CI(0.81,0.98)]后联合手术治疗可改善患者总生存期(overall survival,OS)。NCRT还可显著降低食管癌患者局部复发[OR=0.43,95%CI(0.30,0.58)]和远处转移[OR=0.71,95%CI(0.52,0.93)]发生率。但NCRT[RR=1.30,95%CI(0.77,2.20)]会增加患者术后30 d死亡率。结论 现有的证据表明NCRT联合手术是治疗可切除食管癌患者的最佳选择,但该治疗方法有增加术后30 d死亡率的风险。未来的研究应侧重于优化NCRT方案,以期在改善患者OS的同时有效降低术后死亡率。此外受纳入研究质量的影响,该结论仍需更多高质量的随机对照试验予以佐证。
Objective To explore the best neoadjuvant treatment strategy for esophageal cancer and provide a theoretical basis for clinical formulation of neoadjuvant treatment plan.Methods PubMed,EMbase,The Cochrane Library,Web of Science,CNKI,Wanfang,and VIP were searched from inception to May 2022.Two researchers independently performed literature screening and data extraction.The quality of the studies was evaluated by the Cochrane risk of bias tool,and data analysis was performed in RStudio environment using R3.6.3 software.Results A total of 24 studies were included,covering 5 286 patients treated with surgery alone,neoadjuvant chemotherapy(NCT),neoadjuvant radiotherapy(NRT),or neoadjuvant chemoradiotherapy(NCRT) followed by combined surgical treatment.The risk of bias of the studies was low.The results of the network meta-analysis showed that combined surgical treatments after NCRT [HR=0.77,95%CI(0.70,0.85)] and NCT [HR=0.89,95%CI(0.81,0.98)] were effective methods to improve patients' overall survival(OS) compared with surgery alone.In addition,NCRT could significantly reduce the incidence of local recurrence [OR=0.43,95%CI(0.30,0.58)] and distant metastasis [OR=0.71,95%CI(0.52,0.93)] in patients with esophageal cancer.However,NCRT [RR=1.30,95%CI(0.77,2.20)] increased the mortality rate of patients at 30 d after surgery.Conclusion The available evidence suggests that NCRT combined with surgery is the best option for treating patients with resectable esophageal cancer,but this treatment carries the risk of increased 30 d postoperative mortality.Future studies should focus on optimizing the NCRT regimen with the aim of improving patients' OS while effectively reducing postoperative mortality.In addition,more high-quality randomized controlled trials are needed to support the results of the study.
作者
高鑫
王铄链
许帅
马文文
徐子昂
胡尕伟
李庆新
GAO Xin;WANG Shuolian;XU Shuai;MA Wenwen;XU Ziang;HU Gawei;LI Qingxin(The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army,730050,Lanzhou,P.R.China;Graduate School of Ningxia Medical University,Yinchuan,750004,P.R.China;Graduate School of Hebei North University,Zhangjiakou,075000,Hebei,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2024年第7期1035-1042,共8页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
全军后勤科研计划重大项目(ALJ18J001-7)。
关键词
食管癌
新辅助治疗
化疗
放疗
放化疗
网状Meta分析
Esophageal cancer
neoadjuvant therapy
chemotherapy
radiotherapy
chemoradiotherapy
network meta-analysis
