大劑量化療與標準劑量化療治療原發性高分化骨肉瘤療效的系統評價_《中國循證醫學雜志》

作者：

李同相 ¹ , 白靖平 ¹ , 錫林寶勒日 ¹ , 江仁兵 ¹ , 何祖勝 ¹ , 黃衛民 ² ,  吳泰相 ³

1. 新疆醫科大學附屬腫瘤醫院（烏魯木齊 830054） 2. 新疆建工醫院（烏魯木齊 830002） 3. 四川大學華西醫院中國循證醫學中心/國際臨床流行病學網華西研究與培訓中心（成都 610041）;

關鍵詞：

骨肉瘤大劑量化療標準劑量化療系統評價

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目的　評價大劑量化療治療原發性高分化骨肉瘤的療效是否優于標準劑量化療。
方法　采用Cochrane系統評價方法，檢索MEDLINE、Embase、OVID、Cochrane圖書館臨床對照試驗數據庫、中國生物醫學文獻光盤數據庫，以及手工檢索《中華腫瘤雜志》、《中國腫瘤臨床》、《腫瘤》等（檢索時間為自創刊至2006年2月）。由兩名評價者共同評價納入研究質量，對同質研究進行Meta分析。
結果　共納入4個研究、937例原發性、非轉移性、高分化肢體骨肉瘤患者。所有研究均未描述具體的隨機方法、是否盲法，只有1個研究描述分配隱藏，所有研究均報告了失訪及退出原因以及基線資料。大劑量化療組在5年無瘤生存率 [RR 1.10, 95%CI (0.96, 1.25)] 、5年總生存率 [RR 1.08, 95%CI (0.97, 1.20)]、局部復發率 [RR 0.92, 95%CI (0.54, 1.57)]、組織學反應良好者所占的比例 [RR 0.93, 95%CI (0.81, 1.07)]、保肢率 [RR 0.97, 95%CI (0.92, 1.02)] 方面與低劑量組相比差異無統計學意義；腫瘤對術前化療組織學反應良好與不良的5年無瘤生存率差異有統計學意義。
結論　現有研究結果顯示，腫瘤對術前化療的組織學反應是骨肉瘤的一個獨立的預后因素。大劑量化療治療原發性高分化骨肉瘤不優于低劑量化療，但由于納入研究存在選擇性偏倚、實施偏倚、以及發表偏倚的中度可能性，很可能影響結果的可靠性，期望將來高質量的隨機對照試驗提供更可靠的證據。

引用本文： 李同相,白靖平,錫林寶勒日,江仁兵,何祖勝,黃衛民,吳泰相. 大劑量化療與標準劑量化療治療原發性高分化骨肉瘤療效的系統評價. 中國循證醫學雜志, 2006, 06(11): 826-832. doi: 復制

1.	徐萬鵬, 馮傳漢. 主編. 骨科腫瘤學. 第1版. 北京: 民軍醫出版社; 2001. 179.
2.	Xu WP, Feng CH. Orthopaedic Oncology. First Edition. Beijing: Peoples Military Medical Publisher; 2001. 179.
3.	Horfman HD, Czerniak B. Bone tumors. St Louis: Mosby; 1998: 32–33.
4.	Saeter G, Oliveira J, Bergh J, ESMO Guidelines Task Force. ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of osteosarcoma. Ann Oncol, 2005; 16 (Suppl 1): 73–74.
5.	Dahlin D, Coventry M. Osteogenic sarcoma: a study of six hundred cases. J Bone Joint Surg Am, 1975; 57(3): 397–404.
6.	Enneking WF. An abbreviated history of orthopaedic oncology in North America. Clin Orthop Relat Res, 2000; (374): 115–124.
7.	Goorin AM, Abelson HT, Frei III E. Osteosarcoma: Fifteen years later. N Engl J Med, 1985; 313(26): 1637–1642.
8.	Campanacci M, Bacci G, Bertoni F, et al. The treatment of osteosarcoma of the extremities: twenty years’ experience at theIstituto Ortopedico Rizzoli. Cancer, 1981; 48(7): 1569–1581.
9.	Hudson M, Jaffe MR, Jaffe N, et al. Pediatric osteosarcoma: therapeutic strategies, results and alprognostic factors derived from a 10-year experience. J Clin Oncol, 1990; 8(12): 1988–1997.
10.	Jaffe N. Adjuvant chemotherapy in osteogenic sarcoma. J Clin Oncol, 1984; 2(10): 1179–1181.
11.	Meyers PA, Heller G, Healey J, et al. Chemotherapy for non-metastatic osteosarcoma: the Memorial Sloan-Kettering experience. J Clin Oncol, 1992; 10(1): 5–15.
12.	Eilber F, Giuliano A, Eckardt J, et al. Adjuvant chemotherapy for osteosarcoma: a randomised prospective trial. J Clin Oncol, 1987; 5(1): 21–26.
13.	Bacci G, Avella M, Capanna R, et al. Neoadjuvant chemotherapy in the treatment of osteosarcoma of the extremities: preliminary results in 131 cases treated preoperatively with methotrexate and cisdiamminoplatinum. Italian Journal of Orthopaedics & Traumatology, 1988; 14(1): 23–39.
14.	Gaetano B, Cristiana F, Stefano F, et al. Neoadjuvant chemotherapy forosteosarcoma of the extremity: intensification of preoperative treatment does not increase the rate of good histologic response to the primary tumor or improve the final outcome. J Pediatr Hematal Onco, 2003; 25(11): 845–853.
15.	Meyers PA, Gorlick R, Hellr G, et al. Intensification of preoperative chemotherapy for osteogenic sarcoma:rsults of the memorial sloan-kettering (t12) protocol. Journal of Clinical Oncology, 1998; 16(7): 2452–2458.
16.	Bacci G, Gherlinzoni F, Picci P, et al. Adriamycin-methotrexae high dose as verss adriamycin-methotrexae moderate dose as adjuvant chemotherapy for osteosarcoma of the extremities: a randomized study. Eur J Clin Oncol, 1986; 22(11): 1337–1345.
17.	Souhami L, Craft AW, Van der Eijken JW, et al. Randomized trial of two regmens of chemotherapy in operative osteosarcoma: a study of the European osteosarcoma intergroup. Lancet, 1997; 350(9082): 911–917.
18.	Damron TA, Pritchard DJ. Current combined treatment high-grade osteosarcomas. Oncology, 1995; 9(4): 327–343; discussion 343–344, 347–350.
19.	Meyers PA, Gorlick R. Osteosarcoma. Pediatr Clin North Am, 1997; 44(3): 973–989.
20.	Rosen G, Marcove RC, Caparros B, et al. Primary osteogenic sarcoma:the rational for preoperative chemotherapy and delayed surgery. Cancer, 1979; 43(6): 2163–2177.

1. 徐萬鵬, 馮傳漢. 主編. 骨科腫瘤學. 第1版. 北京: 民軍醫出版社; 2001. 179.
2. Xu WP, Feng CH. Orthopaedic Oncology. First Edition. Beijing: Peoples Military Medical Publisher; 2001. 179.
3. Horfman HD, Czerniak B. Bone tumors. St Louis: Mosby; 1998: 32–33.
4. Saeter G, Oliveira J, Bergh J, ESMO Guidelines Task Force. ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of osteosarcoma. Ann Oncol, 2005; 16 (Suppl 1): 73–74.
5. Dahlin D, Coventry M. Osteogenic sarcoma: a study of six hundred cases. J Bone Joint Surg Am, 1975; 57(3): 397–404.
6. Enneking WF. An abbreviated history of orthopaedic oncology in North America. Clin Orthop Relat Res, 2000; (374): 115–124.
7. Goorin AM, Abelson HT, Frei III E. Osteosarcoma: Fifteen years later. N Engl J Med, 1985; 313(26): 1637–1642.
8. Campanacci M, Bacci G, Bertoni F, et al. The treatment of osteosarcoma of the extremities: twenty years’ experience at theIstituto Ortopedico Rizzoli. Cancer, 1981; 48(7): 1569–1581.
9. Hudson M, Jaffe MR, Jaffe N, et al. Pediatric osteosarcoma: therapeutic strategies, results and alprognostic factors derived from a 10-year experience. J Clin Oncol, 1990; 8(12): 1988–1997.
10. Jaffe N. Adjuvant chemotherapy in osteogenic sarcoma. J Clin Oncol, 1984; 2(10): 1179–1181.
11. Meyers PA, Heller G, Healey J, et al. Chemotherapy for non-metastatic osteosarcoma: the Memorial Sloan-Kettering experience. J Clin Oncol, 1992; 10(1): 5–15.
12. Eilber F, Giuliano A, Eckardt J, et al. Adjuvant chemotherapy for osteosarcoma: a randomised prospective trial. J Clin Oncol, 1987; 5(1): 21–26.
13. Bacci G, Avella M, Capanna R, et al. Neoadjuvant chemotherapy in the treatment of osteosarcoma of the extremities: preliminary results in 131 cases treated preoperatively with methotrexate and cisdiamminoplatinum. Italian Journal of Orthopaedics & Traumatology, 1988; 14(1): 23–39.
14. Gaetano B, Cristiana F, Stefano F, et al. Neoadjuvant chemotherapy forosteosarcoma of the extremity: intensification of preoperative treatment does not increase the rate of good histologic response to the primary tumor or improve the final outcome. J Pediatr Hematal Onco, 2003; 25(11): 845–853.
15. Meyers PA, Gorlick R, Hellr G, et al. Intensification of preoperative chemotherapy for osteogenic sarcoma:rsults of the memorial sloan-kettering (t12) protocol. Journal of Clinical Oncology, 1998; 16(7): 2452–2458.
16. Bacci G, Gherlinzoni F, Picci P, et al. Adriamycin-methotrexae high dose as verss adriamycin-methotrexae moderate dose as adjuvant chemotherapy for osteosarcoma of the extremities: a randomized study. Eur J Clin Oncol, 1986; 22(11): 1337–1345.
17. Souhami L, Craft AW, Van der Eijken JW, et al. Randomized trial of two regmens of chemotherapy in operative osteosarcoma: a study of the European osteosarcoma intergroup. Lancet, 1997; 350(9082): 911–917.
18. Damron TA, Pritchard DJ. Current combined treatment high-grade osteosarcomas. Oncology, 1995; 9(4): 327–343; discussion 343–344, 347–350.
19. Meyers PA, Gorlick R. Osteosarcoma. Pediatr Clin North Am, 1997; 44(3): 973–989.
20. Rosen G, Marcove RC, Caparros B, et al. Primary osteogenic sarcoma:the rational for preoperative chemotherapy and delayed surgery. Cancer, 1979; 43(6): 2163–2177.

《中國循證醫學雜志》

大劑量化療與標準劑量化療治療原發性高分化骨肉瘤療效的系統評價

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《中國循證醫學雜志》

大劑量化療與標準劑量化療治療原發性高分化骨肉瘤療效的系統評價

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