摘要
目的系统性评价全程新辅助治疗(TNT)在局部晚期直肠癌中的疗效和安全性。方法计算机检索PubMed、Embase、Web of Science、Cochrane Library、中国生物医学文献数据库、万方数据库、维普数据库和中国知网等数据库,查阅自建库至2021年5月公开发表的TNT联合全直肠系膜切除术(TME)对比标准治疗方案即新辅助放化疗(nCRT)联合TME治疗局部晚期直肠癌的临床随机对照研究文献,对两组总生存期、无病生存期、R0根治性切除率、病理完全缓解率、T分期降期率、≥3级不良反应(包括中性粒细胞下降、恶心呕吐、腹泻、放射性皮炎和神经系统不良反应等)发生率和术后30 d内并发症发生率等数据,应用Review Manager 5.3软件进行统计分析。结果最终纳入9项研究,共计2430例患者。Meta分析结果显示,TNT组的总生存期(HR=0.80,95%CI:0.65~0.97,P=0.03)和病理完全缓解率(RR=1.73,95%CI:1.44~2.08,P<0.01)均优于nCRT组,差异有统计学意义(均P<0.05);两组无病生存期(HR=0.86,95%CI:0.71~1.05,P=0.14)、R0根治性切除率(RR=1.02,95%CI:0.99~1.06,P=0.17)和T分期降期率(RR=1.04,95%CI:0.89~1.22,P=0.58)差异无统计学意义(均P>0.05)。在治疗安全性方面,两组间≥3级不良反应发生率(RR=1.09,95%CI:0.70~1.70,P=0.70)和术后30 d内并发症发生率(RR=1.07,95%CI:0.97~1.18,P=0.19)差异无统计学意义(均P>0.05)。结论在局部晚期直肠癌的治疗中,TNT相比于nCRT可以带来更多的生存获益,且未明显增加不良反应发生。TNT可能是局部晚期直肠癌患者的一种推荐治疗方案。
Objective To systematically evaluate the efficacy and safety of total neoadjuvant therapy(TNT)in the comprehensive treatment of locally advanced rectal cancer.Methods Literatures were screened from PubMed,Embase,Web of Science,Cochrane Library,CBM,Wanfang Data,VIP and CNKI from the inception date to May 2021 to collect the randomized controlled clinical trials(RCTs)of TNT followed by total mesorectal excision(TME)versus neoadjuvant chemotherapy(nCRT)followed by TME in the treatment of locally advanced rectal cancer.The data of overall survival,disease-free survival,R0 radical resection rate,pathological complete response(pCR)rate,T downstaging rate,the incidence of adverse events≥grade III,including neutropenia,nausea and vomiting,diarrhea,radiation dermatitis and nervous system toxicity,and the morbidity of complications within postoperative 30 days of the two groups were extracted from the included literatures.Review Manager 5.3 software was utilized for statistical meta-analysis.Results Nine RCTs were finally enrolled including 2430 patients.Meta-analysis results showed that compared with nCRT group,patients in TNT group had longer overall survival(HR=0.80,95%CI:0.65-0.97,P=0.03)and higher pCR rate(RR=1.73,95%CI:1.44-2.08,P<0.01)with significant differences.Besides,there were no significant differences between two groups in disease-free survival(HR=0.86,95%CI:0.71-1.05,P=0.14),R0 radical resection rate(RR=1.02,95%CI:0.99-1.06,P=0.17)and T downstaging rate(RR=1.04,95%CI:0.89-1.22,P=0.58)between two groups.In terms of treatment safety,the incidence of adverse events≥grade III(RR=1.09,95%CI:0.70-1.70,P=0.70)and morbidity of complications within postoperative 30 days(RR=1.07,95%CI:0.97-1.18,P=0.19)did not significantly differ between two groups.Conclusions In the treatment of locally advanced rectal cancer,TNT may bring more survival benefits than nCRT and does not increase the incidence of adverse events and postoperative complications.Therefore,TNT could be used as a recommended treatment for patients with locally advanced rectal cancer.
作者
张一擎
孙开国
陆佳莹
马继
姚楠
覃朝晖
姚元虎
Zhang Yiqing;Sun Kaiguo;Lu Jiaying;Ma Ji;Yao Nan;Qin Zhaohui;Yao Yuanhu(Department of Radiation Oncology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;School of Public Health,Xuzhou Medical University,Xuzhou 221004,China;School of Medical Imaging,Xuzhou Medical University,Xuzhou 221004,China)
出处
《中华胃肠外科杂志》
CSCD
北大核心
2022年第6期531-538,共8页
Chinese Journal of Gastrointestinal Surgery
关键词
直肠肿瘤
局部晚期
全程新辅助治疗
新辅助放化疗
总生存期
安全性
META分析
Rectal neoplasms,locally advanced
Total neoadjuvant therapy
Neoadjuvant chemoradiotherapy
Overall survival
Safety
Meta-analysis
