目的:通过网状Meta分析对不同全程新辅助治疗方案的有效性和安全性进行对比。方法:计算机检索PubMed、Embase、Cochrane Library和Web of Science数据库，研究对象为接受磁共振分期的非转移性可切除的局部进展期直肠癌患者，根据同步放化疗和新辅助化疗先后顺序、放疗疗程和化疗方案的不同，将治疗方案分为6组，使用RevMan 5。4和STATA 15。0软件进行分析。结果:共纳入23篇文献，7 699名患者，结果显示，先行同步放化疗后新辅助化疗(CRT/SCRT→FOLFOX/XELOX)方案与先新辅助化疗后同步放化疗(FOLFOX/XELOX化疗→CRT)相比具有较高的病理完全缓解率(OR=1。61，95％CI:1。06～2。45;OR=1。58，95％CI:1。08～2。36)，但肿瘤降期率、R0切除率、不良事件发生率、3年总生存期和无病生存期无显著性差异。结论:CRT→FOLFOX/XELOX是最佳的术前治疗方案，推荐局部进展期直肠癌患者接受同步放化疗后，在手术前行部分或全部周期新辅助化疗。
Efficacy and safety of chemoradiotherapy sequencing on rectal cancer in total neoadjuvant therapy:a sys-tematic review and network Meta-analysis
OBJECTIVE To compare the efficacy and safety of different total neoadjuvant therapy(TNT)regimens by net-work Meta-analysis.METHODS The PubMed,Embase,Cochrane Library and Web of Science databases were searched.The study population was non-metastatic resectable locally advanced rectal cancer(LARC)patients undergoing magnetic resonance Imaging(MRI)staging.The treatment protocols were divided into 6 groups according to the sequence of concurrent chemoradio-therapy(CRT)and neoadjuvant chemotherapy,the course of radiotherapy and the chemotherapy regimen.Network Meta-analysis was performed by using RevMan 5.4 and STATA 15.0 software.RESULTS A total of 23 clinical trials,including 7 699 patients,were included in the network Meta-analysis.The up-front CRT had a higher pathologic complete response(pCR)(OR=1.61,95％CI:1.06-2.45;OR=1.58,95％CI:1.08-2.36)compared to up-front neoadjuvant chemotherapy(FOLFOX/XELOX→CRT).There were no significant differences in tumor downstaging,R0 resection rate,adverse effects rate,3-year overall surival rate and disease free survival rate.CONCLUSION The regimen of CRT→FOLFOX/XELOX is likely the most effective preoperative CRT regimen.It is recommended that LARC patients receive preoperative CRT followed by partial or all cycles of neoadjuvant chemotherapy before surgery.
NETL
NSTL
万方数据
维普
