中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2012年
11期
1150-1155
,共6页
蔡永华%黄美近%邓艳红%吴小剑%王辉%杨祖立%何晓生%汪建平
蔡永華%黃美近%鄧豔紅%吳小劍%王輝%楊祖立%何曉生%汪建平
채영화%황미근%산염홍%오소검%왕휘%양조립%하효생%왕건평
新辅助治疗%直肠肿瘤%随机对照试验%Meta分析
新輔助治療%直腸腫瘤%隨機對照試驗%Meta分析
신보조치료%직장종류%수궤대조시험%Meta분석
Neoadjuvant therapy%Rectal neoplasms%Randomized controlled trial%Metaanalysis
目的 系统评价新辅助治疗在直肠癌中的治疗作用及其对术后并发症的影响.方法 检索2010年5月前在PubMed,Ovid,Web of Science,Springer-Link,Elsevier Science Direct等数据库已公开发表的比较直肠癌新辅助治疗与单纯手术或术后辅助治疗的随机对照试验(RCT),并进行入选标准和质量评价,对符合标准的文献提取相关临床效应指标进行Meta分析.结果 11篇RCT共7407例患者纳入分析,新辅助治疗组3685例,对照组为3722例.直肠癌新辅助治疗组局部复发率(OR=0.43,95％CI:0.37～0.50,P＜0.01)、远处转移率(OR=0.85,95％CI:0.76～0.95,P＜0.01)、5年生存率(RR=1.15,95％CI:1.04～1.28,P＜0.01)及保肛手术率(RR=1.48,95％CI:1.17～1.87,P＜0.01)均优于对照组,差异有统计学意义,但术后死亡率(OR=1.20,95％CI:0.68～2.13,P=0.53)及吻合口并发症发生率(OR=1.04,95％CI:0.73～1.48,P=0.84)的差异无统计学意义.结论 直肠癌新辅助治疗有利于控制局部及远处复发,提高远期生存,未明显增加术后并发症的发生率.
目的 繫統評價新輔助治療在直腸癌中的治療作用及其對術後併髮癥的影響.方法 檢索2010年5月前在PubMed,Ovid,Web of Science,Springer-Link,Elsevier Science Direct等數據庫已公開髮錶的比較直腸癌新輔助治療與單純手術或術後輔助治療的隨機對照試驗(RCT),併進行入選標準和質量評價,對符閤標準的文獻提取相關臨床效應指標進行Meta分析.結果 11篇RCT共7407例患者納入分析,新輔助治療組3685例,對照組為3722例.直腸癌新輔助治療組跼部複髮率(OR=0.43,95％CI:0.37～0.50,P＜0.01)、遠處轉移率(OR=0.85,95％CI:0.76～0.95,P＜0.01)、5年生存率(RR=1.15,95％CI:1.04～1.28,P＜0.01)及保肛手術率(RR=1.48,95％CI:1.17～1.87,P＜0.01)均優于對照組,差異有統計學意義,但術後死亡率(OR=1.20,95％CI:0.68～2.13,P=0.53)及吻閤口併髮癥髮生率(OR=1.04,95％CI:0.73～1.48,P=0.84)的差異無統計學意義.結論 直腸癌新輔助治療有利于控製跼部及遠處複髮,提高遠期生存,未明顯增加術後併髮癥的髮生率.
목적 계통평개신보조치료재직장암중적치료작용급기대술후병발증적영향.방법 검색2010년5월전재PubMed,Ovid,Web of Science,Springer-Link,Elsevier Science Direct등수거고이공개발표적비교직장암신보조치료여단순수술혹술후보조치료적수궤대조시험(RCT),병진행입선표준화질량평개,대부합표준적문헌제취상관림상효응지표진행Meta분석.결과 11편RCT공7407례환자납입분석,신보조치료조3685례,대조조위3722례.직장암신보조치료조국부복발솔(OR=0.43,95％CI:0.37～0.50,P＜0.01)、원처전이솔(OR=0.85,95％CI:0.76～0.95,P＜0.01)、5년생존솔(RR=1.15,95％CI:1.04～1.28,P＜0.01)급보항수술솔(RR=1.48,95％CI:1.17～1.87,P＜0.01)균우우대조조,차이유통계학의의,단술후사망솔(OR=1.20,95％CI:0.68～2.13,P=0.53)급문합구병발증발생솔(OR=1.04,95％CI:0.73～1.48,P=0.84)적차이무통계학의의.결론 직장암신보조치료유리우공제국부급원처복발,제고원기생존,미명현증가술후병발증적발생솔.
Objective To assess the value of neoadjuvant therapy for resectable rectal cancer and the impact on postoperative complications.Methods Literature search was performed in PubMed,Ovid,Web of Science,Springer-Link and Elsevier ScienceDirect for randomized controlled trials published before May 2010 that compared neoadjuvant therapy with surgery alone or postoperative adjuvant therapy.The computer search was supplemented with hand search of reference lists for available primary studies.Inclusion criteria and quality assessment were performed.Results Eleven studies including 7407 patients were enrolled for analysis.Neoadjuvant therapy group had significant advantages in local recurrence(OR=0.43,95％CI:0.37-0.50,P＜0.01),distant recurrence(OR=0.85,95％CI:0.76-0.95,P=＜0.01),5-year overall survival(RR=1.15,95％CI:1.04-1.28,P＜0.01),and sphincter-saving surgery(RR=1.48,95％CI:1.17-1.87,P＜0.01).There were no significant difference in postoperative mortality rate(OR=1.20,95％CI:0.68-2.13,P=0.53)and anastomotic complications(OR=1.04,95％CI:0.73-1.48,P=0.84).Conclusion Neoadjuvant therapy improves local control,distant recurrence and long-term survival without increasing postoperative complications.
