Taxane-Cisplatin-Fluorouracil As Induction Chemotherapy in Locally Advanced Head and Neck Cancers: An Individual Patient Data Meta-Analysis of the Meta-Analysis of Chemotherapy in Head and Neck Cancer Group
Taxane-Cisplatin-Fluorouracil As Induction Chemotherapy in Locally Advanced Head and Neck Cancers: An Individual Patient Data Meta-Analysis of the Meta-Analysis of Chemotherapy in Head and Neck Cancer Group
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DOI：
10.1200/jco.2012.47.7802
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发表时间：
2013-08-10
影响因子：
45.3
通讯作者：
Pignon, Jean-Pierre
中科院分区：
文献类型：
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作者：
Blanchard, Pierre;Bourhis, Jean;Pignon, Jean-Pierre
目的在局部晚期头颈癌（LAHNC）的随机对照试验中，比较了顺铂联合氟尿嘧啶（PF）诱导化疗与紫杉烷（多西他赛或紫杉醇）、顺铂和氟尿嘧啶（Tax-PF）诱导化疗的疗效。本荟萃分析的目的是研究的疗效和毒性的Tax-PF和PF，并确定在亚组的patients.MethodsFive随机试验代表1,772例患者的结果的差异。检索所有试验的更新个体患者数据（IPD）。使用按试验分层的对数秩检验进行比较。相互作用或趋势检验被用来研究协变量和treatment.ResultsMedian随访时间为4.9年之间的相互作用。死亡的风险比（HR）为0.79（95%CI，0.70 - 0.89; P <0.001; 5年绝对获益：7.4%），Tax-PF较好。异质性显著（P = 0.08，I-2 = 51%），与一项试验相关。排除本试验后，异质性不再增加（P = 0.99，I-2 = 0%），死亡HR为0.72（95% CI，0.63 - 0.83），有利于Tax-PF。治疗效果与以下患者协变量之间无相互作用：年龄、性别、体能状态、肿瘤分期或部位。与PF相比，Tax-PF与疾病进展、局部失败和远端失败显著减少相关，HR为0.78（95%CI，0.69 ~ 0.87; P < .001），0.79（95%CI，0.66 ~ 0.94; P = .007），0.63（95%CI，0.45 ~ 0.89; P = .009）。它在LAHNC管理中的确切作用仍有待确定。(C)2013年美国临床肿瘤学会
PurposeCisplatin plus fluorouracil (PF) induction chemotherapy has been compared with taxane (docetaxel or paclitaxel), cisplatin, and fluorouracil (Tax-PF) in randomized trials in locoregionally advanced head and neck cancers (LAHNCs). The aim of this meta-analysis was to study the efficacy and toxicity of Tax-PF and PF and identify differences in outcomes in subsets of patients.MethodsFive randomized trials representing 1,772 patients were identified. Updated individual patient data (IPD) were retrieved for all trials. The log-rank test, stratified by trial, was used for comparison. Interaction or trend tests were used to study the interaction between covariates and treatment.ResultsMedian follow-up was 4.9 years. The hazard ratio (HR) of death was 0.79 (95% CI, 0.70 to 0.89; P < .001; absolute benefit at 5 years: 7.4%) in favor of Tax-PF. Heterogeneity was significant (P = .08, I-2 = 51%) and related to one trial. There was no more heterogeneity after exclusion of this trial (P = .99, I-2 = 0%), and HR of death was 0.72 (95% CI, 0.63 to 0.83) in favor of Tax-PF. There was no interaction between treatment effect and the following patient covariates: age, sex, performance status, tumor stage, or site. Tax-PF was associated with significant reductions of progression, locoregional failure, and distant failure compared with PF, with HRs of 0.78 (95% CI, 0.69 to 0.87; P < .001), 0.79 (95% CI, 0.66 to 0.94; P = .007), and 0.63 (95% CI, 0.45 to 0.89; P = .009) respectively.ConclusionThis IPD meta-analysis shows the superiority of Tax-PF over PF as induction chemotherapy. Its precise role in the management of LAHNC remains to be determined. (C) 2013 by American Society of Clinical Oncology