摘要
目的系统评价热疗联合放疗或放化疗治疗原发性鼻咽癌及其颈淋巴结转移的疗效及安全性。方法计算机检索Cochrane图书馆、Pub Med、EMBASE、Web of Science、中国生物医学文献数据库、中国学术期刊网络出版总库、维普中文科技期刊数据库和万方数字化期刊全文数据库八大数据库,同时辅以其他检索,收集所有热疗综合疗法治疗鼻咽癌的随机对照试验。文献筛选、资料提取和质量评价后,使用Rev Man5.1软件进行Meta分析。结果共纳入21篇随机对照研究(1 680例患者)。Meta分析结果显示:1原发灶热放组的完全缓解率[比值比3.13,95%可信区间(2.00,4.92)]和总有效率[比值比6.84,95%可信区间(1.48,31.60)]均显著好于单放组,且其差异均有统计学意义(P<0.05);2颈部转移灶热放组的完全缓解率[比值比3.89,95%可信区间(2.26,6.71)]和总有效率[比值比6.96,95%可信区间(2.15,22.48)]均显著好于单放组,且其差异均有统计学意义(P<0.05);3颈部转移灶热放化组的完全缓解率[比值比3.02,95%可信区间(2.12,4.29)]、总有效率[比值比5.02,95%可信区间(1.64,15.33)]、3年总生存率[比值比2.81,95%可信区间(1.82,4.34)]、5年总生存率[比值比2.00,95%可信区间(1.34,2.99)]、5年无瘤生存率[比值比4.05,95%可信区间(2.55,6.43)]和5年局部控制率[比值比8.70,95%可信区间(3.59,21.12)]均显著好于放化组,且其差异均有统计学意义(P<0.05)。结论相较于单纯放疗或放化疗,热疗综合疗法治疗鼻咽癌及其颈淋巴结转移能提高患者的近期疗效或远期生存率,且安全性较好,但其长期疗效和安全性评价尚需大样本高质量的随机对照研究进一步验证。
Objective To evaluate the clinical efficacy and safety of hyperthermia combined with radiotherapy or radio-chemotherapy in treating primary nasopharyngeal cancer, and to provide references for clinical practice and research. Methods We searched foreign databases such as Cochrane Library, PubMed, EMBASE, Web of Science and Chinese ones including CBM, CNKI, VIP and WanFang with computer. In addition, we also retrieved other sources for supplying. All relevant randomized controlled trials （RCTs） were collected to compare hyperthermia combination therapy with radio-chemotherapy or radiotherapy alone. After literature screening, data extraction and quality evaluation were performed in accordance with the criteria of Cochrane handbook, the meta-analysis was conducted using RevMan 5.1 software. Results Twenty-one RCTs were selected with 1 680 patients included. Meta-analysis showed：① The treatment group underwent radiotherapy plus intracavity hyperthermia for nasopharyngeal cancer. The complete response and total effective rate of treatment group were both higher than the control group with radiotherapy alone, the OR value and 95%CI were [3.13, （2.00,4.92）] and [6.84, （1.48,31.60）], respectively, and the differences between the two groups showedstatistical significance （P〈0.05）;② The treatment group underwent hyperthermo-radiotherapy for cervical lymph node metastasis from nasopharyngeal cancer. The complete response and total effective rate of treatment group were both higher than the control group with radiotherapy alone, the OR value and 95%CI were [3.89, （2.26,6.71）] and [6.96, （2.15, 22.48） 1, respectively, and the differences between the two groups showed statistical significance （P〈0.05）; ③ The treatment group underwent hyperthermo-radio-chemotherapy for cervical lymph node metastasis from nasopharyngeal cancer. The complete response and total effective rate, 3-5-year survival rate, 5-year local control and progression free survival rate, these in the treatment group were all superior to radio-chemotherapy alone group, the OR value and 95%CI were [3.02, （2.12,4.29）], [5.02, （1.64,15.33）], [2.81, （1.82,4.34）], [2.00, （1.34,2.99）], [4.05, （2.55,6.43）1, and [8.70, （3.59,21.12）], respectively, and the differences between the two groups were of statistical significance （P〈 0.05）. Conclusion Compared with radio-chemotherapy or radiotherapy alone, hyperthermia combination therapy for nasopharyngeal cancer and cervical lymph node metastasis can improve long-term survival rate or short-term curative effect. Additionally, it is safe and feasible. However, its long-term survival rate and safety still need to be further verified by more large sample and high quality RCTs.
出处
《循证医学》
CSCD
2015年第2期96-101,107,共7页
The Journal of Evidence-Based Medicine
关键词
鼻咽癌
热疗
放疗
化疗
随机对照试验
系统评价
META分析
nasopharyngeal cancer
hyperthermia
radiotherapy
chemotherapy
randomized controlled trial
systematic review
meta-analysis
