新辅助化疗加手术治疗局部晚期宫颈癌的Meta分析
Meta Analysis on Neoadjuvant Chemotherapy with Radical Surgery in Locally Advanced Cervical Cancer
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摘要: 目的 评价新辅助化疗治疗局部晚期宫颈癌的临床疗效。 方法 电子检索Cochrane 图书馆、MEDLINE、EMBASE、PubMed、CBMdisc数据库,收集符合纳入标准的文献,提取资料、评价纳入研究的方法学质量,并提取有效数据进行Meta分析。 结果 符合纳入标准共5篇文章,4篇为前瞻性随机对照试验,1篇为回顾性病例对照研究。新辅助化疗对局部晚期宫颈癌的5年生存率没有影响（相对危险度1.07,95%可信区间0.88~1.29,P=0.51）,但提高了局部晚期宫颈癌的5年无瘤生存率（相对危险度1.13,95%可信区间1.0~1.27,P=0.01）;降低了术后淋巴结转移率及宫旁浸润率（相对危险度0.48,95%可信区间0.34~0.7,P<0.000 1;相对危险度0.54,95%可信区间0.36~0.83,P<0.001）。 结论 新辅助化疗可用于治疗局部晚期宫颈癌,可降低术后宫旁浸润率及淋巴结转移率。但纳入的研究少且都为小样本的研究,因此新辅助化疗对局部晚期宫颈癌的疗效有待进一步大样本、高质量、多中心、随机双盲对照试验加以证实。Abstract: Objective To evaluate the clinical efficacy of neoadjuvant chemotherapy （NACT） and radical surgery（RS） in locally advanced cervical cancer. Methods The following electronic databases were searched: CBMdisc,MEDLNE, PubMed, EMBASE, Cochrane Library. All eligible documents were assessed for quality, and extracted data were performed by a meta-analysis. Results 5 articles met the inclusion criteria, among which were four prospective randomized controlled trials and one retrospective case-control study. NACT and RS did not increase the 5-year survival rate, but increased the 5-year disease-free survival rate and decreased lymph node metastasis and parameter metastasis. Conclusion NACT and RS could be chosen to treat the locally advanced cervical cancer. It increased the 5-year disease-free survival rate and decreased lymph node metastasis and parameter metastasis. But the conclusion is needed to be further assessed by rigorously designed, randomized, double-blind, controlled trials.
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