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目的:系统评价术后辅助化疗对成人脑恶性胶质瘤的临床疗效及安全性。方法:计算机检索PubMed、Cochrane Library、EMBASE、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库,并辅手工和其他检索,搜集国内外术后辅助化疗治疗成人脑恶性胶质瘤的随机对照试验。由2名评价员独立筛选文献和提取资料,并对其方法学质量进行评价,采用RevMan 5.0软件进行统计分析。结果:共纳入13个随机对照试验(3 639例患者),Meta分析结果显示:与术后单纯放疗相比,术后辅助化疗可提高1～2年生存率和2年无疾病进展生存率,其OR和95%CI,分别为0.61(0.43,0.87),0.52(0.33,0.81),0.42(0.19,0.90);对1年无疾病进展生存率和5年生存率差异无显著性,其OR和95%CI,分别为0.52(0.26,1.04),0.75(0.54,1.04)。5个研究(2 418例)报告了患者在治疗期间发生的不良反应,术后辅助化疗不良反应发生率较术后单纯放疗高。结论:恶性胶质瘤患者术后采取辅助化疗措施可以提高其1和2年生存率,尤其是1年生存率,对于提高2年和5年无疾病进展生存率可能有价值。由于纳入文献质量的原因,尚需进一步开展高质量的随机对照试验,验证其疗效与安全性。
Objective: To systematically evaluate the clinical efficacy and safety of postoperative adjuvant chemotherapy for adult brain malignant gliomas. METHODS: PubMed, Cochrane Library, EMBASE, Chinese Journal Full-text Database, Chinese Biomedical Literature Database, Chinese Science and Technology Periodical Full-text Database were searched by computer, and assisted by manual and other retrieval methods to collect postoperative adjuvant chemotherapy at home and abroad for the treatment of adult patients with glioblastoma Randomized controlled trial. Two reviewers independently screened the literature and extracted data, and evaluated its methodological quality, using RevMan 5.0 software for statistical analysis. Results: A total of 13 randomized controlled trials (3,639 patients) were included. The results of Meta analysis showed that postoperative adjuvant chemotherapy increased the 1- and 2-year survival rates and 2-year disease-free survival rate compared with postoperative radiotherapy. The OR and 95% CI were 0.61 (0.43,0.87), 0.52 (0.33,0.81) and 0.42 (0.19,0.90) respectively. There was no significant difference in 1-year disease-free survival rate and 5-year survival rate. OR And 95% CI, respectively 0.52 (0.26, 1.04), 0.75 (0.54, 1.04). Five studies (2 418 cases) reported adverse reactions during treatment and postoperative adjuvant chemotherapy was associated with a higher incidence of adverse reactions than postoperative radiotherapy alone. Conclusions: Adjuvant chemotherapy in patients with malignant gliomas may improve their 1-year and 2-year survival rates, especially 1-year survival rates, and may be of value in improving 2-year and 5-year disease-free survival rates. Due to the quality of the included literature, further high-quality randomized controlled trials are still needed to verify their efficacy and safety.