Chemotherapy in locally advanced nasopharyngeal carcinoma: An individual patient data meta-analysis of eight randomized trials and 1753 patients
Chemotherapy in locally advanced nasopharyngeal carcinoma: An individual patient data meta-analysis of eight randomized trials and 1753 patients
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DOI：
10.1016/j.ijrobp.2005.06.037
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发表时间：
2006-01-01
影响因子：
7
通讯作者：
Pignon, JP
中科院分区：
文献类型：
--
作者：
Baujat, B;Audry, W;Pignon, JP
目的：研究放疗加化疗对鼻咽癌患者总生存期和无事件生存期的影响。方法与材料：这项荟萃分析使用的是局部晚期鼻咽癌化疗加放疗与单纯放疗的随机试验的最新个体数据。结果：共纳入8个试验，1753例患者。一项采用2×2设计的试验在分析中计算了两次。这项分析包括使用1975名患者的数据进行11次比较。中位随访时间为6年。合并死亡风险比为0.82(95%可信区间为0.71-0.94；p=0.006)，相当于化疗后5年的绝对生存收益为6%(从56%增加到62%)。肿瘤失败或死亡的合并风险比为0.76(95%可信区间为0.67-0.86；p<；0.0001)，相当于化疗后5年的绝对无事件生存收益为10%(从42%到52%)。化疗时机与总生存率之间存在显著的交互作用(p=0.005.0 5)，说明了治疗效果的异质性(p=0.0 3)，其中同期化疗的益处最高。当化疗与RT同时进行时，基本上观察到了这一益处。(C)2006年埃尔塞维尔公司。
Objectives: To study the effect of adding chemotherapy to radiotherapy (RT) on overall survival and event-free survival for patients with nasopharyngeal carcinoma.Methods and Materials: This meta-analysis used updated individual patient data from randomized trials comparing chemotherapy plus RT with RT alone in locally advanced nasopharyngeal carcinoma. The log-rank test, stratified by trial, was used for comparisons, and the hazard ratios of death and failure were calculated.Results: Eight trials with 1753 patients were included. One trial with a 2 X 2 design was counted twice in the analysis. The analysis included 11 comparisons using the data from 1975 patients. The median follow-up was 6 years. The pooled hazard ratio of death was 0.82 (95% confidence interval, 0.71-0.94; p = 0.006), corresponding to an absolute survival benefit of 6% at 5 years from the addition of chemotherapy (from 56% to 62%). The pooled hazard ratio of tumor failure or death was 0.76 (95% confidence interval, 0.67-0.86; p < 0.0001), corresponding to an absolute event-free survival benefit of 10% at 5 years from the addition of chemotherapy (from 42% to 52%). A significant interaction was observed between the timing of chemotherapy and overall survival (p = 0.005), explaining the heterogeneity observed in the treatment effect (p = 0.03), with the highest benefit resulting from concomitant chemotherapy.Conclusion: Chemotherapy led to a small, but significant, benefit for overall survival and event-free survival. This benefit was essentially observed when chemotherapy was administered concomitantly with RT.(c) 2006 Elsevier Inc.