【摘要】：背景和目的:鼻咽癌是頭頸部較常見(jiàn)的惡性腫瘤之一,因其獨(dú)特的病理類型,放射治療具有重要的地位。鼻咽癌早期癥狀和體征不明顯,大多數(shù)患者一旦確診往往已是晚期。鼻咽癌的遠(yuǎn)處轉(zhuǎn)移和復(fù)發(fā)嚴(yán)重影響了鼻咽癌患者的生存率,成為治療失敗的主要原因。如何提高鼻咽癌患者的局部控制率、減少遠(yuǎn)處轉(zhuǎn)移或復(fù)發(fā)和提高總生存,已經(jīng)成為當(dāng)前鼻咽癌治療的重中之重。一直以來(lái),FP方案(氟尿嘧啶+順鉑)都作為晚期鼻咽癌的標(biāo)準(zhǔn)一線化療方案,然而,并沒(méi)有明確的循證醫(yī)學(xué)證據(jù)。近年來(lái),一些研究表明,GP方案對(duì)于晚期鼻咽癌治療有效。所以,本文將運(yùn)用meta分析的方法,比較GP方案(吉西他濱+順鉑)和FP方案(氟尿嘧啶+順鉑)治療晚期鼻咽癌的療效和不良反應(yīng),以期為晚期鼻咽癌患者的治療選擇提供更加科學(xué)、合理的化療方案。方法:計(jì)算機(jī)檢索PubMed、Cochrane Library、EMbase、SCI、Medcine、Ovid、CBM、CNKI、維普等數(shù)據(jù)庫(kù),同時(shí)輔助其它檢索方式(截止到2016年7月),納入GP和FP方案比較治療晚期鼻咽癌的臨床隨機(jī)對(duì)照試驗(yàn)(RCTs),按照J(rèn)adad質(zhì)量計(jì)分法對(duì)納入的每篇文獻(xiàn)進(jìn)行方法學(xué)質(zhì)量評(píng)估,使用RevMan5.3軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:使用計(jì)算機(jī)檢索相關(guān)中英文數(shù)據(jù)庫(kù),共納入符合標(biāo)準(zhǔn)的文獻(xiàn)14篇,包括10篇中文和4篇英文,共1253例晚期鼻咽癌患者,其中GP組607例,FP組646例。利用RevMan5.3軟件對(duì)收集的數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,結(jié)果顯示:GP方案和FP方案相比,在治療晚期鼻咽癌療效方面:1年生存率(RR=1.07,95%CI:1.01~1.13,p=0.03)、3年生存率(RR=1.20,95%CI:1.07~1.33,p=0.001)和客觀緩解率(RR=1.23,95%CI:1.09~1.40,p=0.0009)有統(tǒng)計(jì)學(xué)差異,說(shuō)明GP方案優(yōu)于FP方案;在不良反應(yīng)方面:血液學(xué)毒性無(wú)明顯統(tǒng)計(jì)學(xué)差異(p≥0.05);消化道反應(yīng)(惡心、嘔吐)相對(duì)較低(p0.00001)。結(jié)論:GP與FP方案相比,具有較好的療效和更輕微的毒副作用,結(jié)合之前學(xué)者的臨床試驗(yàn)結(jié)果,可考慮將GP方案作為晚期鼻咽癌的一線治療方案。該結(jié)論有待于進(jìn)一步加大樣本量進(jìn)行證實(shí)。
[Abstract]:Background and objective: nasopharyngeal carcinoma (NPC) is one of the most common malignant tumors in head and neck. The early symptoms and signs of nasopharyngeal carcinoma are not obvious, and most patients are usually late once diagnosed. Distant metastasis and recurrence of nasopharyngeal carcinoma (NPC) have seriously affected the survival rate of NPC patients and become the main cause of failure in treatment. How to improve the local control rate, reduce distant metastasis or recurrence and improve the overall survival of nasopharyngeal carcinoma patients has become the most important treatment of nasopharyngeal carcinoma. FP regimen (fluorouracil cisplatin) has been used as the standard first-line chemotherapy regimen for advanced nasopharyngeal carcinoma, however, there is no clear evidence-based medical evidence. In recent years, some studies have shown that GP regimen is effective in the treatment of advanced nasopharyngeal carcinoma. Therefore, meta analysis was used to compare the efficacy and side effects of GP regimen (gemcitabine cisplatin) and FP regimen (fluorouracil cisplatin) in the treatment of advanced nasopharyngeal carcinoma. In order to provide a more scientific and rational chemotherapy regimen for patients with advanced nasopharyngeal carcinoma. Methods: a computer-based search was made for the database of PubMedus Cochrane Library EMbase, SCI, Ovidine, CBM, CNKI, etc. At the same time, other retrieval methods (as of July 2016) were included in the clinical randomized controlled trial (RCTs), which included GP and FP schemes for the treatment of advanced nasopharyngeal carcinoma, and were evaluated according to Jadad quality scoring method for each article included. The software Revman 5.3 was used for statistical analysis. Results: a total of 14 articles including 10 Chinese and 4 English were included in the relevant Chinese and English databases. 1253 patients with advanced nasopharyngeal carcinoma were included in this study, including 607 patients in GP group and 646 in FP group. The data collected were statistically analyzed with RevMan5.3 software. The results showed that the 1-year survival rate (RRR1.0795 CI: 1.01C: 1.13p0.03), the 3-year survival rate (RRRR1.20c95CIW 1.071.33 p0.001) and the objective remission rate (RRR1.2395 CI: 1.09: 1.40p0.0009) were significantly different in the treatment of advanced nasopharyngeal carcinoma compared with FP regimen. The results showed that GP regimen was superior to FP regimen in side effects: hematological toxicity was not significantly different (p 鈮，

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