徐敏+曹德东+戈伟

[摘要] 目的 系统评价热疗联合化疗治疗晚期或胸壁复发乳腺癌疗效及安全性。 方法 计算机检索PubMed、Web of Science、EMbase、重庆维普数据库、中国学术期刊全文数据库、中国生物医学文献数据库、万方数据库所收录的相关研究，搜索年限从建库到2017年3月22日。研究对象为晚期或胸壁复发乳腺癌，治疗组采用热疗联合化疗，对照组采用单纯化疗。比较两组疗效及安全性。使用Cochrane手册5.1.0版的质量评价标准对纳入研究进行质量评价，使用RevMan5.1.0版软件进行数据分析。 结果 最终纳入8项研究，共519例患者。Meta分析结果表明，与对照组比较，治疗组有效率及疾病控制率提高（OR=2.15，95%CI：1.50～3.09，P < 0.01）、（OR = 2.26，95%CI：1.42～3.60，P=0.0006），白细胞减少（OR = 0.75，95%CI：0.43～1.32，P=0.32）、中性粒细胞减少（OR = 1.12，95%CI：0.58～2.18，P=0.73）、胃肠道反应（OR = 1.00，95%CI：0.59～1.70，P=1.00）、肝肾损害（OR = 0.97，95%CI：0.55～1.74，P=0.93）等差异无统计学意义。 结论 与单纯化疗相比，热疗联合化疗治疗晚期或胸壁复发乳腺癌可提高疗效，且不增加不良反应。受纳入研究质量限制和可能存在的发表偏倚影响，上述结果尚需更高质量的随机对照研究来验证。

[关键词] 熱疗联合化疗；化疗；乳腺癌；Meta分析

[中图分类号] R737.9 [文献标识码] A [文章编号] 1673-7210（2017）09（b）-0004-06

Meta analysis of efficacy and safety of hyperthermia combined with chemotherapy in the treatment of advanced or chest wall recurrence of breast cancer

XU Min CAO Dedong GE Wei

Department Ⅱ of Oncology， People's Hospital of Wuhan University， Hubei Province， Wuhan 430060， China

[Abstract] Objective To evaluate the effectiveness and safety of hyperthermia combined with chemotherapy in the treatment of late or chest wall recurrence of breast cancer. Methods Electronic databases including the PubMed， Web of Science， EMbase， VIP， China national knowledge internet， Chinese biomedical literature database and Wanfang database system were searched， search term from building to March 22， 2017. The inclusion criteria was efficacy and safety studies of controlled clinical studies in which hyperthermia combined with chemotherapy was compared with chemotherapy alone for patients with late or chest wall recurrence of breast cancer. Cochrane handbook 5.1.0 was applied in evaluating the quality of included trials and RevMan 5.1.0 software was used for data analysis. Results Eight studies including 519 cases of late or chest wall recurrence of breast cancer were included. The results of the Meta-analysis exhibited that compared with chemotherapy alone， hyperthermia combined with chemotherapy could increase effective rate （OR=2.15， 95%CI： 1.50-3.09， P < 0.01） and disease control rate （OR = 2.26， 95%CI： 1.42-3.60， P=0.0006）. But there were no significant differences in rate of leucopenia （OR = 0.75， 95%CI： 0.43-1.32， P=0.32）， rate of neutropenia （OR = 1.12， 95%CI： 0.58-2.18， P=0.73）， rate of gastrointestinal reaction （OR = 1.00， 95%CI： 0.59-1.70， P=1.00）， rate of liver and kidney dysfunction （OR = 0.97， 95%CI： 0.55-1.74， P=0.93）. Conclusion Compared with chemotherapy alone， hyperthermia combined with chemotherapymay be more effective for late or chest wall recurrence of breast cancer， whereas adverse reactions are similar. For the quality restriction and possible publication bias of the included studies， more high quality randomized controlled trials are required to further verify this conclusion.endprint

[Key words] Hyperthermia combined with chemotherapy； Chemotherapy； Breast cancer； Meta analysis

乳腺癌是女性最常见的恶性肿瘤之一，近年来，其发病率及死亡率已跃居女性恶性肿瘤首位[1]。术后胸壁局部复发是肿瘤进展的表现，属于临床晚期乳腺癌[2]。化疗是治疗晚期乳腺癌主要手段之一。如何提高乳腺癌患者对化疗的敏感性及化疗的有效率，是当前乳腺癌治疗中亟待解决的临床问题。热疗是继手术、化疗、放射治疗、靶向治疗后的第五大抗肿瘤治疗手段[3]。有学者详细介绍了热疗在肿瘤治疗中的临床应用及应用价值[4]。研究表明，热疗联合化疗可以提高乳腺癌患者的临床疗效，且相对安全，有良好的应用能前景[5-12]。尽管有较多热疗联合化疗治疗乳腺癌的基础及临床研究，但目前疗效尚无定论，国内外尚缺乏对该治疗模式的系统评价。……