新辅助化疗联合手术与单纯手术治疗结肠癌疗效的Meta分析

摘要

目的 比较新辅助化疗联合手术与单纯手术治疗结肠癌的临床疗效.方法 计算机检索PubMed、EMbase、Cochrane Li-brary、CNKI、万方数据库,查找关于比较两种治疗方案治疗结肠癌临床疗效的随机对照试验,检索时间为建库至2017年9月,对纳入的文献进行质量评价及数据提取,采用RevMan 5.3统计软件进行Meta分析.结果 纳入研究的文献共10篇,患者共3159例,其中新辅助化疗联合手术治疗者1595例,单纯手术治疗者1564例.Meta分析结果显示,新辅助化疗组与单纯手术组腹腔感染发生率(RR=1.07,95% CI:0.70~1.64,P=0.76)、吻合口瘘发生率(RR=1.90,95% CI:0.72~5.04,P=0.20)、5年OS(RR=1.04, 95% CI:0.99~1.10,P=0.13)、5年DFS(RR=0.97,95% CI:0.91~1.05,P=0.49)相比,差异无统计学意义,但与单纯手术组相比,新辅助化疗组R0切除率更高(RR=1.10,95% CI:1.05~1.16,P<0.0001)、肿瘤直径更小(MD= -0.24,95% CI:-0.41 ~-0.06,P=0.009)、肿瘤浸润固有肌层深度更浅(MD= -2.52,95% CI:-3.32~ -1.71,P<0.00001)、3年OS更高(RR=1.07, 95% CI:1.02~1.13,P=0.01)、远处转移发生率更低(RR=0.66,95% CI:0.50~0.86,P=0.002).结论 新辅助化疗联合手术治疗结肠癌可以缩小肿瘤直径、提高肿瘤的R0切除率、提高3年OS、减少转移的疗效,同时不提高患者的腹腔感染、吻合口瘘的风险,也不会缩短患者的5年OS和DFS.%Objective To compare the efficacy of preoperative neoadjuvant chemotherapy combined with surgery and surgery alone for colon cancer. Methods The databases included PubMed,EMbase,Cochrane Library,CNKI,Wan-Fang were retrieved. And the studies about the comparison of efficacy between preoperative neoadjuvant chemotherapy combined with surgery (neoadjuvant group) and surgery alone (surgery group) for colon cancer were collected. The quality of included studies was assessed,and the data were collected. Then the Meta-analysis was performed to compare the efficacy of neoadjuvant chemotherapy combined with surgery and surgery alone.Results Ten studies were involved, which consisted of 3 159 patients. Meta-analysis showed that there were no significant differences in the 5-year overall survival (RR=1.04,95% CI:0.99-1.10,P=0.13),5-year disease-free survival (RR=0.97,95% CI:0.91-1.05,P=0.49),anastomotic leakage (RR=1.90,95% CI:0.72-5.04,P=0.20) or rate of abdominal infection (RR=1.07,95% CI:0.70-1.64,P=0.76) between neoadjuvant group and surgery group. Compared with surgery group,tumor diameter was reduced (MD= -0.24,95% CI: -0.41- -0.06, P=0.009), R0 resection rate was improved (RR=1.10,95% CI:1.05-1.16, P<0.0001), the rate of metastasis was reduced (RR=0.66,95% CI:0.50-0.86,P=0.002),3-year overall survival was improved (RR=1.07,95% CI:1.02-1.13, P=0.01) and the depth of tumor infiltration propria was more shallowed (MD = -2.52,95% CI: -3.32 - -1. 71,P <0.00001) in the neoadjuvant group.Conclusion Neoadjuvant chemotherapy can reduce tumor diameter, improve R0 resection rate,improve 3-year overall survival, reduce recurrence and metastasis for colon cancer, but have no differ-ences in anastomotic leakage,rate of abdominal infection,5-year overall survival,5-year disease-free survival.