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目的:系统评价紫杉类-顺铂-氟尿嘧啶联合诱导化疗治疗晚期头颈癌的疗效和安全性。方法:计算机检索PubMed、Embase、SpringerLink、MEDLINE和the Cochrane Library数据库,检索时限从建库至2015年2月,纳入有关紫杉类-顺铂-氟尿嘧啶联合诱导化疗治疗晚期头颈癌的文献。由2名评价员按照纳入与排除标准独立筛选文献、提取资料和评价质量后,使用Stata 13.0软件进行Meta分析。结果:共纳入7个RCT,2 702例患者,Meta分析结果显示:与顺铂-氟尿嘧啶组对比,紫杉类-顺铂-氟尿嘧啶组的3年生存率[HR=1.14,95%CI(1.03,1.25),P<0.01]、3年无进展生存率[HR=1.24,95%CI(1.08,1.43),P<0.01]、5年生存率[HR=1.30,95%CI(1.09,1.55),P<0.01]、5年无进展生存率[HR=1.39,95%CI(1.14,1.70),P<0.01]和总有效率[OR=1.66,95%CI(1.35,2.05),P<0.01]均明显优于顺铂-氟尿嘧啶组。对于毒副作用,中性粒细胞减少性发热[OR=2.36,95%CI(1.62,3.46),P<0.01]、脱发[OR=8.22,95%CI(3.99,16,92),P<0.01]、腹泻[OR=1.57,95%CI(1.05,2.36),P<0.05]和白细胞减少症[OR=2.79,95%CI(1.86,4.21),P<0.01]的发生率高于顺铂-氟尿嘧啶组。结论:相对于顺铂-氟尿嘧啶组,紫杉类-顺铂-氟尿嘧啶联合诱导化疗提高了晚期头颈癌的无进展生存期、生存率和总有效率,但有着更高的不良事件发生率。
OBJECTIVE: To systematically evaluate the efficacy and safety of the combined chemotherapy of taxane, cisplatin and fluorouracil in the treatment of advanced head and neck cancer. METHODS: The databases of PubMed, Embase, SpringerLink, MEDLINE and the Cochrane Library were searched by computer. The search period was from the establishment of the library to February 2015, and the literature about the combined chemotherapy of taxane, cisplatin and fluorouracil for advanced head and neck cancer was included. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted data and evaluated the quality, and then conducted a meta-analysis using Stata 13.0 software. Results: A total of 7 RCTs were enrolled in 2 702 patients. Meta-analysis showed that the 3-year survival rate of the taxane-cisplatin-fluorouracil group was significantly higher than that of cisplatin-fluorouracil group [HR = 1.14,95% CI , 1.25), P <0.01]. The 3-year progression-free survival rate [HR = 1.24,95% CI 1.08,1.43, P <0.01] and 5-year survival [HR = 1.30,95% CI ), P <0.01], 5-year progression-free survival rate (HR = 1.39,95% CI 1.14,1.70, P <0.01) and total effective rate (OR = 1.66,95% CI 1.35,2.05) <0.01] were significantly better than cisplatin - fluorouracil group. For toxic side effects, neutropenic fever [OR = 2.36,95% CI 1.62,3.46, P <0.01], hair loss [OR 8.22,95% CI 3.99,16,92, P 0.01 (OR = 1.57, 95% CI 1.05, 2.36, P 0.05) and leucopenia (OR 2.79, 95% CI 1.86, 4.21, P 0.01) were significantly higher than those of cisplatin fluoruracil group. Conclusions: The combination of taxane-cisplatin-fluorouracil and chemotherapy with cisplatin-fluorouracil increases progression-free survival, overall survival and overall survival of patients with advanced head and neck cancer, but has a higher incidence of adverse events.