Efficacy and toxicity of different concurrent chemoradiotherapy regimens in the treatment of advanced cervical cancer: A network meta-analysis.
Efficacy and toxicity of different concurrent chemoradiotherapy regimens in the treatment of advanced cervical cancer: A network meta-analysis.
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不同并发化学疗法方案在晚期宫颈癌治疗中的功效和毒性：网络荟萃分析。
DOI：
10.1097/md.0000000000005853
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发表时间：
2017-01
期刊：
影响因子：
1.6
通讯作者：
Sun YM
中科院分区：
文献类型：
--
作者：
Fu ZZ;Li K;Peng Y;Zheng Y;Cao LY;Zhang YJ;Sun YM
本研究的目的是通过网络荟萃分析，比较不同同步放化疗（CCRT）方案治疗晚期宫颈癌（CC）的疗效和毒性。我们检索了PubMed和Cochrane图书馆从这些数据库建立到2016年9月，所有与不同CCRT治疗CC方案相关的队列研究（CSs）都被纳入。采用网络分析比较直接和间接证据的组合，分析优势比（OR），在不同CCRT方案治疗CC的疗效和毒性累积排序曲线下绘制曲面，并采用聚类分析根据相似的治疗方案对各类别进行分组。本网络荟萃分析共纳入19个CSs，包括12个CCRT方案（放疗[RT]、CCRT[顺铂]、CCRT[长春瑞滨]、CCRT[紫杉醇]、CCRT[顺铂+ FU]、CCRT[顺铂+吉西他滨]、CCRT[顺铂+紫杉醇]、CCRT[顺铂+氨fostine]、CCRT[顺铂+ FU +羟基脲]、CCRT[顺铂+长春瑞滨]）。网络荟萃分析结果显示，在疗效方面，CCRT（顺铂+多西他赛）的总有效率高于RT， CCRT（顺铂+ FU +羟基脲）的5年总生存率（OS）相对高于CCRT（羟基脲）。毒性方面，CCRT（顺铂）组白细胞减少发生率低于CCRT（羟基脲）、CCRT（顺铂+ FU）和CCRT（顺铂+紫杉醇）组，腹泻和呕吐发生率低于CCRT（顺铂）组（吉西他滨）。此外，聚类分析显示，CCRT（顺铂）的血液毒性和胃肠道毒性发生率相对较低，CCRT（紫杉醇）的胃肠道毒性低于其他方案。我们的研究表明，CCRT（顺铂+多西他赛）可能是治疗CC的最佳选择，而CCRT（顺铂+ FU +羟基脲）的5年OS率可能是这些不同方案中最高的。CCRT（顺铂）可能是所有CCRT方案中毒性最低的。
Supplemental Digital Content is available in the text The aim of this study was to compare the efficacy and toxicity of different concurrent chemoradiotherapy (CCRT) regimens in the treatment of advanced cervical cancer (CC) by adopting a network meta-analysis. We searched PubMed and Cochrane Library from the inception of these databases to September 2016, and all cohort studies (CSs) related to different CCRT regimens in the treatment of CC were included. A network analysis was adopted to compare the combination of direct and indirect evidence, to analyze the odds ratio (OR), and to draw a surface under the cumulative ranking curve of the efficacy and toxicity of different CCRT regimens for CC. Cluster analyses were used to group each category based on similar treatment regimens. Nineteen CSs were enrolled in this network meta-analysis, including 12 CCRT regimens (radiotherapy [RT], CCRT [cisplatin], CCRT [vinorelbine], CCRT [paclitaxel], CCRT [hydroxyurea], CCRT [cisplatin + FU], CCRT [cisplatin + gemcitabine], CCRT [cisplatin + docetaxel], CCRT [cisplatin + paclitaxel], CCRT [cisplatin + amifostine], CCRT [cisplatin + FU + hydroxyurea], and CCRT [cisplatin + vincristine + bleomycin]). The results of the network meta-analysis showed that regarding efficacy, the overall response rate of CCRT (cisplatin + docetaxel) was higher than RT, and the 5-year overall survival (OS) rate of CCRT (cisplatin + FU + hydroxyurea) was relatively higher than CCRT (hydroxyurea). As for toxicity, CCRT (cisplatin) had a lower incidence of leukopenia than CCRT (hydroxyurea), CCRT (cisplatin + FU) and CCRT (cisplatin + paclitaxel), and the incidences of diarrhea and vomiting in CCRT (cisplatin) were lower than those in CCRT (cisplatin + gemcitabine). Additionally, the cluster analysis showed that CCRT (cisplatin) had relatively lower incidences of both hematotoxicity and gastrointestinal toxicity, and CCRT (paclitaxel) had lower gastrointestinal toxicity than other regimens. Our study demonstrated that CCRT (cisplatin + docetaxel) might be the best choice of CCRT regimens in the treatment of CC, and the 5-year OS rate of CCRT (cisplatin + FU + hydroxyurea) might be the highest among these different regimens. CCRT (cisplatin) might have the lowest toxicity among all the CCRT regimens.