Clinical Efficacy Of Concomitant Chemoradiotherapies For Postoperative High-risk Endometrial Cancer:A Meta-analysis

Objective:To investigate the curative effect of combined chemoradiotherapy and radiotherapy alone in high-risk endometrial carcinoma.Methods:The inclusion criteria were formulated and the search strategies were determined.The computer searched EMBASE,Cochrane library,Pubmed,CNKI,Wanfang,VIP,Chinese medical literature database,and other databases.The retrieval time was from January 1990 to December 2018.The literature screening,quality assessment and data extraction were completed by two people independently.In this meta-analysis,Revman 5.3 developed by the Cochrane collaboration group was used for statistical analysis of the included studies.The heterogeneity of pooled statistics was analyzed using the forest plot of the software.If the heterogeneity test results are P>0.1 and I~2<50%,multiple independent studies are considered to have homogeneity,and the fixed-effect model is used.On the contrary,it means that multiple studies have heterogeneity,random effect model is used.The potential publication bias was determined by observing the asymmetry of the Funnel plot.Begg's and Egger's test was also used to assess publication bias.Other biases were assessed using State15.1sensitivity analysis.Adverse reactions were reported according to the us NCI Version3.0 adverse events(AE)standard.Results:A total of 8 literatures that met the inclusion criteria were selected,including 1literature containing 2RCTs.The Revman5.3 developed by the Cochrane collaboration group was used for statistical analysis of the included studies and the results were as follows:progression-free survival rate?RR=1.07,95%CI(1.02,1.13)P=0.004?,cancer specific survival rate?RR=1.09,95%CI(1.01,1.18)P=0.03?,and grade 3/4 adverse reaction rate?RR=5.16,95%CI(4.14,6.44)P<0.00001?was higher than that in the radiotherapy alone group,and the local recurrence rate?RR=0.50,95%CI(0.33,0.74)P=0.0005?was lower than that in the radiotherapy alone group.There was statistically significant difference between the two groups.The overall survival rate?RR=1.07,95%CI(0.99,1.15)P=0.08?in the combined radiotherapy group was higher than that in the radiotherapy group alone and the distant metastasis rate?RR=0.82,95%CI(0.59,1.14)P=0.24?was lower than that in the radiotherapy alone group.There was no statistically significant difference between the two groups.Conclusions:1.Compared with radiotherapy alone,chemoradiotherapy can significantly improve the progression-free survival rate,cancer-specific survival rate and local recurrence rate in the postoperative adjuvant treatment for high-risk endometrial cancer of stage ?-?.2.In the postoperative adjuvant treatment of stage ?-? high-risk endometrial cancer,combined radiotherapy and chemotherapy cannot effectively improve the survival rate of patients and reduce the distant metastasis of patients compared with radiotherapy alone.3.In the postoperative adjuvant treatment of stage ?-? high-risk endometrial cancer,compared with radiotherapy alone,grade 3-4 adverse reactions rate are higher in chemoradiotherapy.