Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): A comprehensive analysis by tumour site
Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): A comprehensive analysis by tumour site
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DOI：
10.1016/j.radonc.2011.05.036
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发表时间：
2011-07-01
影响因子：
5.7
通讯作者：
Pignon, Jean-Pierre
中科院分区：
文献类型：
--
作者：
Blanchard, Pierre;Baujat, Bertrand;Pignon, Jean-Pierre
简介：最近更新的头颈癌化疗荟萃分析 (MACH-NC) 证明了添加化疗对头颈鳞状细胞癌 (HNSCC) 总生存期的益处。根据肿瘤部位的获益程度以及它们与患者或试验特征的潜在相互作用尚不清楚。方法：本分析纳入了 1965 年至 2000 年期间进行的 87 项随机试验。根据肿瘤部位将患者分为四类：口腔、口咽、下咽和喉。排除其他肿瘤位置的患者（999，5.7%）。对于每个肿瘤位置和化疗时间，使用按试验分层的对数秩检验来比较治疗。计算死亡或复发的风险比。研究了患者或试验特征与化疗效果之间的相互作用。结果：分析了 16,192 名患者的个体患者数据，中位随访时间为 5.6 年。添加的益处在所有肿瘤部位都是一致的，风险比在 0.87 和 0.88 之间（交互作用的 p 值 = 0.99）。所有肿瘤部位同时给药的化疗获益较高，但化疗时机和治疗效果之间的交互作用测试仅对口咽肿瘤（p < 0.0001）和喉肿瘤（p = 0.05）显着，而对口腔肿瘤（p = 0.15）和下咽肿瘤（p = 0.30）不显着。对于口腔、口咽、喉和下咽肿瘤，伴随化疗相关的 5 年绝对获益分别为 8.9%、8.1%、5.4% 和 4%。 结论：在局部区域治疗中加入化疗的获益在所有 HNSCC 肿瘤部位中是一致的。仅针对口咽部和喉部肿瘤证明了同步时间表的更高益处，但这可能只是缺乏动力的结果。 (c) 2011 Elsevier Ireland Ltd. 保留所有权利。放射治疗与肿瘤学100 (2011) 33-40
Introduction: The recently updated meta-analysis of chemotherapy in head and neck cancer (MACH-NC) demonstrated the benefit of the addition of chemotherapy in terms of overall survival in head and neck squamous cell carcinoma (HNSCC). The magnitude of the benefit according to tumour site is unknown as well as their potential interactions with patient or trial characteristics.Methods: Eighty seven randomized trials performed between 1965 and 2000 were included in the present analysis. Patients were divided into four categories according to tumour location: oral cavity, oropharynx, hypopharynx and larynx. Patients with other tumour location were excluded (999, 5.7%). For each tumour location and chemotherapy timing, the logrank-test, stratified by trial, was used to compare treatments. The hazard ratios of death or relapse were calculated. Interactions between patient or trial characteristics and chemotherapy effect were studied.Results: Individual patient data of 16,192 patients were analysed, with a median follow-up of 5.6 years. The benefit of the addition is consistent in all tumour locations, with hazard ratios between 0.87 and 0.88 (p-value of interaction = 0.99). Chemotherapy benefit was higher for concomitant administration for all tumour locations, but the interaction test between chemotherapy timing and treatment effect was only significant for oropharyngeal (p < 0.0001) and laryngeal tumours (p = 0.05), and not for oral cavity (p = 0.15) and hypopharyngeal tumours (p = 0.30). The 5-year absolute benefits associated with the concomitant chemotherapy are 8.9%, 8.1%, 5.4% and 4% for oral cavity, oropharynx, larynx and hypopharynx tumours, respectively.Conclusion: The benefit of the addition of chemotherapy to locoregional treatment is consistent in all tumour locations of HNSCC. The higher benefit of concomitant schedule was demonstrated only for oropharyngeal and laryngeal tumours but this may be only a consequence of a lack of power. (c) 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 100 (2011) 33-40