中高危局限期前列腺癌大分割及常规分割放疗疗效对比——Meta分析

Abstract

目的 比较中高危局限期前列腺癌大分割放疗与常规分割放疗的疗效、不良反应的差异.方法 通过计算机检索国内外相关数据库,搜集有关中高危局限期前列腺癌大分割放疗及常规分割放疗比较的临床对照研究资料,采用Stata12.0软件进行分析.两组间差异采用HR和RR及95%CI描述.结果 根据纳入排除和标准,最终纳入5项包括1621例患者的临床对照研究资料.Meta分析结果显示两组OS率(HR=1.00,95%CI为0.85-1.17,P=0.980)和生化失败结果(RR=0.87,95%CI为0.68-1.12,P=0.274)均相似.与常规分割放疗比较,大分割放疗组≥2级急性胃肠反应发生率偏高(RR=1.94,95%CI为1.23-3.06,P=0.004).两组≥2级急性泌尿系统不良反应(RR=1.03,95%CI为0.92-1.14,P=0.626),晚期≥2级胃肠(RR=1.17,95%CI为0.90-1.51,P=0.238)和泌尿系统(RR=1.11,95%CI为0.94-1.30,P=0.228)不良反应均相似(P值均>0.05).结论 中高危局限期前列腺癌大分割放疗与常规分割放疗疗效相当,虽然大分割放疗组急性胃肠反应发生率略高于常规分割组,但两组晚期胃肠和泌尿系统反应并无差异,患者可耐受.

Objective To compare the efficacy and adverse effects of hypofractionated radiotherapy versus conventionally fractionated radiotherapy for intermediate-to high-risk localized prostate cancer.Methods A literature search was performed in PubMed, Embase, Web of Science, CNKI, VIP database, and Wanfang Data to collect the controlled clinical trials of hypofractionated radiotherapy versus conventionally fractionated radiotherapy in patients with intermediate-to high-risk localized PCa published up to August 31, 2016.Stata 12.0 was used for meta-analysis.The difference between two groups was estimated by calculating the hazard ratio (HR) or risk ratio (RR) with 95%confidence interval (CI).ResultsAccording to the inclusion and exclusion criteria, a total of 5 controlled clinical trials involving 1621 patients with PCa were included in this meta-analysis.The meta-analysis showed that overall survival (HR=1.00, 95%CI:0.85-1.17, P=0.980) and biochemical failure (RR=0.87, 95%CI:0.68-1.12, P=0.274) were comparable between the two groups.Compared with the conventionally fractionated radiotherapy, the incidence of acute gastrointestinal adverse events (grade≥2) was significantly higher in the hypofractionated radiotherapy (RR=1.94, 95%CI:1.23-3.06, P=0.004).However, there were no significant differences in the incidence of acute genitourinary adverse events (grade≥2)(RR=1.03, 95%CI:0.92-1.14,P=0.626), late gastrointestinal adverse events (grade≥2)(RR=1.17,95%CI:0.90-1.51, P=0.238), and late genitourinary adverse events (grade≥2)(RR=1.11, 95%CI:0.94-1.30, P=0.228) between the two groups.Conclusions Conventionally fractionated radiotherapy and hypofractionated radiotherapy have comparable therapeutic effects in patients with intermediate-to high-risk localized PCa.Although the patients treated with hypofractionated radiotherapy have a higher incidence of acute gastrointestinal adverse events than those treated with conventionally fractionated radiotherapy, the incidence of late gastrointestinal and genitourinary adverse events is comparable between the two groups of patients and the adverse effects are tolerable.