中间危险因素的存在降低了根治性子宫切除术的可预测性,要求使用辅助治疗治疗早期宫颈癌(ESCC)患者。辅助放疗(RT)和放化疗(CRT)已被广泛使用,具有多种疗效和安全性问题。因此,本系统综述和荟萃分析的目的是更新现有证据,并评估术后辅助RT与辅助CRT对治疗有中危因素的ESCC患者的生存率和并发症/毒性的影响.PubMed,使用相关关键词的组合搜索EMBASE和WebofScience(WOS)和CENTRAL。在无复发生存期(RFS)方面,所有研究比较了辅助RT与CRT在具有中危因素的ESCC患者中的结局,纳入总生存期(OS)和毒性/并发症.进行了定性和定量分析。使用纽卡斯尔-渥太华量表(NOS)进行回顾性队列研究的偏倚风险评估,并使用Cochrane偏倚风险评估工具进行随机临床试验。本综述包括11项回顾性队列研究和2项随机临床试验。发现辅助CRT在具有多个中间危险因素的ESCC患者中具有更好的RFS,OR为3.1195%CI[1.04,4.99],p<0.0001;i2=6%。然而,在存在单一中间危险因素OR1.8095%CI[0.96,3.36]的两种方案之间观察到相似的益处,p=0.07;i2=0%。在接受术后辅助RT与辅助CRT的患者中,3级或4级血液学毒性显示,与辅助CRT的毒性相关性增加,OR为7.7395CI[3.40,17.59],p<0.0001;i2=62%。在具有多个中间危险因素的ESCC患者中,辅助CRT显示出良好的RFS和OS。CRT还显示3或4级血液学和非血液学毒性的发生率更高,然而,在推荐剂量内使用时,同样可以很好地耐受。
The presence of intermediate risk factors reduces the predictability of radical hysterectomy, demanding the use of adjuvant therapy for treatment of Early stage cervical cancer (ESCC) patients. Adjuvant radiotherapy (RT) and chemoradiotherapy (CRT) has been widely used with varied efficacy and safety issues. Therefore, the aim of this systematic
review and meta-analysis was to update the available evidence and assess the effect of post-surgical adjuvant RT versus adjuvant CRT on survival rate and complications/toxicities in management of ESCC patients with intermediate risk factors. PubMed, EMBASE and Web of Science (WOS) and CENTRAL were searched using a combination of relevant keywords. All studies comparing outcomes of adjuvant RT versus CRT in ESCC patients with intermediate-risk factors in terms of recurrence free survival (RFS), overall survival (OS) and toxicities/complications were included. Both qualitative and quantitative analysis was carried out. The risk of bias assessment was done using Newcastle-Ottawa scale (NOS) for retrospective cohort studies and Cochrane risk of bias assessment tool was used for randomized clinical trials. Eleven retrospective cohort studies and two randomized clinical trials were included in this
review. Adjuvant CRT was found to have better RFS with ESCC patients with multiple intermediate risk factors with OR 3.11 95% CI [1.04, 4.99], p < 0.0001; i2 = 6%. However, similar benefit was observed between both regimens in presence of a single intermediate risk factor OR 1.80 95% CI [0.96, 3.36], p = 0.07; i2 = 0%. Grade 3 or 4 haematological toxicity among patients receiving post-surgical adjuvant RT versus adjuvant CRT showed increased association of toxicity with adjuvant CRT with OR 7.73 95%CI [3.40, 17.59], p < 0.0001; i2 = 62%. Adjuvant CRT shows favourable RFS and OS in ESCC patients with multiple intermediate risk factors. CRT also showed greater incidence of grade 3 or 4 haematological and non-haematiological toxicity, however, the same could be well tolerated when used within the recommended dosage.