Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 93 randomised trials and 17,346 patients
Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 93 randomised trials and 17,346 patients
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DOI：
10.1016/j.radonc.2009.04.014
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发表时间：
2009-07-01
影响因子：
5.7
通讯作者：
Bourhis, Jean
中科院分区：
文献类型：
--
作者：
Pignon, Jean-Pierre;le Maitre, Aurelie;Bourhis, Jean
背景资料：我们之前的个体患者数据（IPD）荟萃分析显示，化疗改善了非转移性头颈部鳞状细胞癌（HNSCC）治愈性治疗患者的生存率，伴随化疗的获益更高。然而，结果的异质性限制了结论，并促使我们通过增加1994年至2000年进行的随机试验在更完整的数据库中证实结果。方法：更新的IPD荟萃分析包括1965年至2000年进行的比较HNSCC患者局部区域治疗与局部区域治疗+化疗的试验。使用按试验分层的对数秩检验比较治疗。结果：24个新的试验，其中大部分是伴随化疗，共87个试验和16,485例患者。死亡风险比为0.88（p < 0.0001），5年时化疗的绝对获益为4.5%，化疗时机（辅助、诱导或伴随）和治疗之间存在显著的相互作用（p < 0.0001）。直接（6项试验）和间接比较均显示，与诱导化疗相比，伴随化疗的获益更显著。对于50项伴随试验，风险比为0.81（p < 0.0001），5年时的绝对获益为6.5%。随着年龄的增长，化疗的效果逐渐降低（p = 0.003，趋势检验）。结论：证实了伴随化疗的益处，并且其益处大于诱导化疗的益处。(C)2009爱思唯尔爱尔兰有限公司保留所有权利。放射治疗与肿瘤学92（2009）4-14
Background: Our previous individual patient data (IPD) meta-analysis showed that chemotherapy improved survival in patients curatively treated for non-metastatic head and neck squamous cell carcinoma (HNSCC), with a higher benefit with concomitant chemotherapy. However the heterogeneity of the results limited the conclusions and prompted us to confirm the results on a more complete database by adding the randomised trials conducted between 1994 and 2000.Methods: The updated IPD meta-analysis included trials comparing loco-regional treatment to loco-regional treatment + chemotherapy in HNSCC patients and conducted between 1965 and 2000. The log-rank-test, stratified by trial, was used to compare treatments. The hazard ratios of death were calculated.Results: Twenty-four new trials, most of them of concomitant chemotherapy, were included with a total of 87 trials and 16,485 patients. The hazard ratio of death was 0.88 (p < 0.0001) with an absolute benefit for chemotherapy of 4.5% at 5 years, and a significant interaction (p < 0.0001) between chemotherapy timing (adjuvant, induction or concomitant) and treatment. Both direct (6 trials) and indirect comparisons showed a more pronounced benefit of the concomitant chemotherapy as compared to induction chemotherapy. For the 50 concomitant trials, the hazard ratio was 0.81 (p < 0.0001) and the absolute benefit 6.5% at 5 years. There was a decreasing effect of chemotherapy with age (p = 0.003, test for trend).Conclusion: The benefit of concomitant chemotherapy was confirmed and was greater than the benefit of induction chemotherapy. (C) 2009 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 92 (2009) 4-14