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目的 探讨术前放化疗(chemoradiotherapy followed by surgery,CRTS)对比单纯手术(surgery alone,SA)治疗可切除食管癌患者的有效性以及安全性。方法 检索Pub Med、Ovid、SCI,中国生物医学文献数据库、中国学术期刊全文数据库、维普数据库、万方数据库等,收集2015年8月1日以前有关术前放化疗与单纯手术治疗可切除食管癌的文献,严格按照纳入和排除标准进行筛选后提取数据。数据分析采用Stata12.0软件。结果 共纳入26个随机对照试验(RCT),研究对象共3 252例,其中CRTS组1 606例,SA组1 646例。CRTS组3年生存率、5年生存率、R0切除率高于SA组,其RR(95%CI,P值)分别为1.24(1.13~1.36,P<0.000 1)、1.29(1.10~1.50,P=0.001)、1.13(1.05~1.21,P=0.001),同时降低了局部复发率与局部复发并远处转移率,其RR(95%CI,P值)分别为0.67(0.52~0.85,P=0.001)、0.60(0.40~0.90,P=0.013),其差异均有统计学意义(P<0.05),两组1年生存率与远处转移率差异均无统计学意义,其RR(95%CI,P值)分别为1.05(0.99~1.12,P=0.103)、0.84(0.70~1.00,P=0.053)。与SA组比较,CRTS组总并发症、术后30 d死亡率、肺部感染、吻合口瘘、吻合口狭窄、心脏并发症、乳糜胸的发生率并未增加,其RR(95%CI,P值)分别为1.09(0.96~1.24,P=0.166)、1.32(0.96~1.83,P=0.485)、1.45(0.94~2.23,P=0.091)、0.89(0.63~1.25,P=0.485)、0.93(0.64~1.35,P=0.731)、1.24(0.84~1.87,P=0.283)、1.62(0.85~3.07,P=0.142),其差异均无统计学意义。结论 与SA相比,CRTS治疗可切除食管癌有效性更高,安全性相当。
Objective To investigate the efficacy and safety of preoperative chemoradiotherapy followed by surgery (CRTS) compared with surgery alone (SA) in the treatment of resectable esophageal cancer patients. Methods PubMed, Ovid, SCI, Chinese biomedical literature database, Chinese academic journals full text database, VIP database, Wanfang database were collected and collected before August 1, 2015 for preoperative chemoradiation and surgical treatment of resectable esophageal cancer The literature, in strict accordance with inclusion and exclusion criteria for screening data extraction. Data analysis using Stata12.0 software. Results A total of 26 randomized controlled trials (RCTs) were included in this study. A total of 3 252 patients were included, of which 1 606 were in the CRTS group and 1 646 in the SA group. The 3-year survival rate, 5-year survival rate and R0 resection rate in CRTS group were higher than those in SA group (RR = 95% CI, P = 1.24, 1.13-1.36, P <0.001), 1.13 (1.05-1.21, P = 0.001), while the local recurrence rate and local recurrence and distant metastasis rate were decreased. The RR (95% CI, P value) were 0.67 = 0.001), 0.60 (0.40-0.90, P = 0.013), the difference was statistically significant (P <0.05). There was no significant difference in the 1-year survival rate and distant metastasis rate between the two groups % CI, P values) were 1.05 (0.99-1.12, P = 0.103) and 0.84 (0.70-1.00, P = 0.053) respectively. Compared with the SA group, the overall complication, mortality at 30 days, lung infection, anastomotic fistula, anastomotic stenosis, cardiac complications and chylothorax did not increase in CRTS group. The RR (95% CI, P values were 1.09 (0.96-1.24, P = 0.166), 1.32 (0.96-1.83, P = 0.485), 1.45 (0.94-2.23, P = 0.091), 0.89 (0.64-1.35, P = 0.731), 1.24 (0.84-1.87, P = 0.283), 1.62 (0.85-3.07, P = 0.142), the difference was not statistically significant. Conclusions Compared with SA, CRTS is more effective and safe in resectable esophageal cancer.