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中华放射肿瘤学杂志
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中华放射肿瘤学杂志  2019, Vol. 28 Issue (12): 901-904    DOI: 10.3760/cma.j.issn.1004-4221.2019.12.005
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局部晚期直肠癌短程新辅助放疗与长程新辅助放疗联合延迟手术疗效比较
许星宇1, 董亚勤2, 杨林2, 熊茂明1
1安徽医科大学第一附属医院胃肠外科,合肥 230022;
2安徽医科大学第一附属医院放疗科,合肥 230022
Short-course versus long-course neoadjuvant radiotherapy combined with delayed surgery for locally advanced rectal cancer:a Meta-analysis
Xu Xingyu1, Dong Yaqin2, Yang Lin2, Xiong Maoming1
1Department of Gastroenterology Surgery First Affiliated Hospital Anhui Medical University Hefei 230000 Cina;
2Department of Radiation Oncology First Affiliated Hospital Anhui Medical University Hefei 230000 Cina
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摘要 目的 短程新辅助放疗(SCRT)联合延迟手术似乎比SCRT联合立即手术更安全,但SCRT联合延迟手术和长程新辅助放疗(LCRT)联合延迟手术的疗效比较尚不明确,因此对两种治疗方案在局部晚期直肠癌患者中的安全性和有效性进行Meta分析方法 利用相关数据库进行相关文献的搜索,对于患者基线特点和治疗结果数据进行提取,对纳入的研究进行偏倚风险评估,并进行证据评价和做出数据分析。结果 共纳入7个研究总计患者4967例。SCRT联合延迟手术和LCRT联合延迟手术在保肛率、R0切除率、术后并发症、局部复发率(LRR)、远处转移、无复发生存(RFS)、总生存(OS)、住院日方面和急性放疗不良反应均相近(P>0.05)。LCRT比SCRT联合延迟手术增加了肿瘤降期率(RR=0.84,95%CI为0.76~0.93,P<0.05)和更高的病理完全缓解率(RR = 0. 46,95% CI = 0. 34~0. 61, P<0. 05)。结论 SCRT联合延迟手术和LCRT联合延迟手术在保肛率、R0切除率、术后并发症、LRR、RFS、OS、住院日和急性3-4级不良反应相近,后者提高了降期率和病理完全缓解率。
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许星宇
董亚勤
杨林
熊茂明
关键词 直肠肿瘤/新辅助放射疗法 直肠肿瘤/外科学 荟萃分析    
AbstractObjective Short-course neoadjuvant radiotherapy (SCRT) combined with delayed surgery seems to be safer than SCRT in combination with immediate surgery. However,the clinical efficacy between SCRT and long-course neoadjuvant radiotherapy (LCRT) combined with delayed surgery has not been compared. Therefore, this meta-analysis was performed to compare the safety and efficacy between SCRT and LCRT followed by delayed surgery in patients with locally advanced rectal cancer. Methods Relevant literatures were searched using relevant databases. Baseline characteristics and treatment results of patients were extracted. The included studies were subject to bias risk assessment. Evidence assessment and data analysis were conducted. Results A total of 7 studies with 4967 patients were included. Meta-analysis results illustrated no statistical significance between two groups in terms of sphincter preservation rate,R0 resection rate,postoperative complications,local recurrence rate (LRR),distant metastasis,recurrence-free survival (RFS),overall survival (OS),length of hospital stay and acute radiotherapy toxicity (all P>0.05). Compared with SCRT with delayed surgery,LCRT with delayed surgery was associated with a significant increase in the tumor downstaging rate (RR=0.84,95%CI=0.76-0.93,P<0.05) and a considerable increase in pathologically complete remission rate (RR=0.46,95%CI=0.34-0.61,P<0.05). Conclusions SCRT with delayed surgery is as effective as LCRT with delayed surgery in terms of sphincter preservation rate,R0 resection rate,postoperative complications,LRR,RFS,OS,grade Ⅲ-Ⅳ acute toxicity and length of hospital stay. However, LCRT in combination with delayed surgery enhances the tumor downstaging rate and pathologically complete remission rate.
Key wordsRectal neoplasm/neoadjuvant radiotherapy    Rectal neoplasm/surgery    Meta-analysis   
收稿日期: 2019-06-08     
基金资助:安徽省2019年重点研究与开发计划(201904a07020045)
通讯作者: 熊茂明,Email:xiongmm1@163.com   
引用本文:   
许星宇,董亚勤,杨林等. 局部晚期直肠癌短程新辅助放疗与长程新辅助放疗联合延迟手术疗效比较[J]. 中华放射肿瘤学杂志, 2019, 28(12): 901-904.
Xu Xingyu,Dong Yaqin,Yang Lin et al. Short-course versus long-course neoadjuvant radiotherapy combined with delayed surgery for locally advanced rectal cancer:a Meta-analysis[J]. Chinese Journal of Radiation Oncology, 2019, 28(12): 901-904.
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