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目的以荟萃分析的方式系统评价髓母细胞瘤患者术后辅助放化疗与单纯放疗的有效性及安全性。方法通过计算机检索国内外主要文献数据库PubMed(Medline)、EMbase、Cochrane图书馆、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库和维普数据库中关于髓母细胞瘤患者术后放化疗疗效比较的临床随机对照试验(RCT),并对符合质量标准的文献进行综合系统评价。结果本研究共纳入6项符合标准的临床随机对照试验,包括1132例患者,其中放化疗组564例,单纯放疗组568例。本次研究的两个主要结局指标显示,髓母细胞瘤患者术后辅助放化疗可明显增加无事件生存期(EFS)[HR=0.83,95%CI(0.69,0.99),P=0.03],而对总体生存期(OS)的影响无明显统计学意义[HR=0.86,95%CI(0.50,1.49),P=0.60]。结论本次Meta分析表明:髓母细胞瘤患者术后辅助放化疗可显著提高患者的EFS,但对OS无明显作用。“三明治”式化疗并不能提高患者的EFS,术后辅助放化疗与单纯放疗相比,两者引起患者的血液系统并发症的风险相似,而对于高危险组患者的术后放化疗的疗效判定仍需大规模多中心高质量的临床随机对照试验。
Objective To evaluate the efficacy and safety of adjuvant chemoradiotherapy and radiotherapy alone in patients with medulloblastoma by meta-analysis. Methods The computerized retrieval of major medulloblastoma patients from PubMed (Medline), EMbase, Cochrane Library, CBM, CNKI, VIP database and VIP database was searched by computer. Postoperative chemoradiotherapy clinical randomized controlled trials (RCT), and to meet the quality standards of the literature a comprehensive systematic review. Results A total of 6 RCTs were included in the study, including 1132 patients, 564 patients in radiotherapy and chemotherapy group and 568 patients in radiotherapy group. Two main outcome measures of this study showed that postoperative adjuvant chemoradiation chemotherapy in patients with medulloblastoma significantly increased event-free survival (EFS) [HR = 0.83, 95% CI (0.69, 0.99), P = 0.03] The overall survival (OS) was not statistically significant (HR = 0.86, 95% CI, 0.50, 1.49, P = 0.60). Conclusions This meta-analysis shows that postoperative adjuvant chemoradiation chemotherapy in patients with medulloblastoma can significantly improve the EFS, but has no significant effect on OS. “Sandwich” chemotherapy does not improve the EFS of patients. Adjuvant chemoradiation and postoperative adjuvant chemoradiation are similar in risk to patients with hematologic complications compared with radiotherapy. However, postoperative chemoradiation Therapeutic effect still requires large-scale multicenter high-quality clinical randomized controlled trials.