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儿童髓母细胞瘤的化疗疗效及预后因素的系统评价 |
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【摘要】 目的：系统评价儿童髓母细胞瘤的疗效及预后因素。方法：计算机检索国内外5个最大的医学数据库，收集国内外与儿童髓母细胞瘤化疗有关的临床随机对照试验文献,进行质量学评价。Meta分析采用RevMan 4.2.8软件。结果：共纳入了4篇临床随机对照试验文献。Meta分析结果显示：化疗可以提高儿童髓母细胞瘤的5年无事件生存率(EFS)[RR=1.21,95%CI(1.06,1.38)，P<0.01]。高危患者化疗的5年EFS优于不化疗者[RR=1.92，95%CI(1.33～2.78)，P<0.01]。化疗对儿童髓母细胞瘤的5年总生存率(OS)与不化疗者无明显差异[RR=1.08，95%CI(0.95～1.23),P>0.05]。肿瘤非全切者的5年EFS低于全切者[OR=0.66,95%CI(0.47～0.93),P<0.05];低级别肿瘤(T1、T2期)的5年EFS高于高级别肿瘤(T3、T4期) [OR=2.08,95%CI(1.47～2.94),P<0.01]。低年龄组的5年EFS显著低于高年龄组[RR=0.67,95%CI(0.49～0.90),P<0.01]。结论：儿童髓母细胞瘤的综合治疗加化疗可以提高其EFS，推迟肿瘤的复发，特别是对高危患者。化疗对总生存率的影响不大。肿瘤不全切除、较高T分期和低年龄患者都是显著降低患者5年生存率的因素。
【关键词】 髓母细胞瘤; 放疗; 化疗; 随机对照试验; Meta分析
A systematic review for the treatment of childhood medulloblastoma preradiation chemotherapy versus radiotherapy alone
MA Ning, LIU Chen, BAO Yuhai, et al
Department of Neurosurgery, First Affiliated Hospital, Xinjiang Medical University,
Urumqi 830011, China
Abstract: Objective: To assess systematically the the outcome of therapies and the prognostic factors for childhood medullublastoma. Methods: We searched the largest medical literature data base in the world on line, and looked up the relevant Chinese and English neurosurgical journals. Randomized controlled trials and clinical controlled trials of chemotherapy for childhood medulloblastoma were included. The quality of trials were critically assessed. RevMan 4.2.8 software was used for Meta analysis. Results: Four RCTs of preradiation chemotherapy versus radiotherapy for childhood medulloblastoma were included. The results of metaanalysis showed that preradiation chemotherapy for childhood medullublastoma increased the eventfree survival [RR=1.21, 95% CI (1.06, 1.38) P=0.004]. More advantage of eventfree survival achieved for children with advanced stages disease treated in radiotherapy plus chemotherapy group. The difference of overall survival failed to show statistically significant between two protocols [RR [1] [2] [3] [4] [5] 下一页
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