| Objective To compare survival rate and toxicity of concurrent chemoradiotherapy and sequential chemoradiotherapy for postoperative cervical cancer patients with risk factors through meta-analysis,and to provide more effective treatment methods with the least adverse reactions for patients after cervical cancer surgery,reduce patient pain,and provides a strong reference for clinicians for adjuvant treatment of patients with cervical cancer after surgery.Methods 1.Search China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP Database for Chinese Technical Periodicals(VIP),the Chinese Biological Medicine Database(CBM),Pub Med,Embase,Web of science,Cochrane Library and other databases by computer to collect randomized controlled trials comparing survival rate and toxicity of concurrent chemoradiotherapy and sequential chemoradiotherapy in patients with early cervical cancer after surgery.2.Retrieval strategy:According to the retrieval problem,transform into PICOS mode,formulate a retrieval strategy,use a combination of subject headings and free word retrieval,optimize the retrieval strategy after repeated retrieval,and at the same time,search for references to supplement relevant literature.Retrieval time limit:From the establishment of each database to November 2020.Search languages:Chinese,English。3.Evaluation of literature quality:According to the inclusion criteria and exclusion criteria,under the guidance of Cochrane Manual of Systematic Review 5.1.0,two researchers started to screen literature and extract data respectively,and at the same time evaluated the quality of the included literature and checked each other.If there is any disagreement,it will be resolved by a third researcher.Literature quality evaluation uses a new"bias risk assessment"tool,which is jointly developed by editors,system evaluators and methodologists of Cochrane collaborative network.4.The Cochrane Collaboration Network’s special software Rev Man 5.4 was used for Meta-analysis.If P>0.1 and I~2≤50%,it indicates that the heterogeneity of the included studies is small,and the fixed effect model is used to calculate the combined statistics,If P≤0.1 and I~2>50%,it indicates that there is great heterogeneity in the included studies,the random effect model is used to calculate the combined statistics.If the outcome index is a binary variable,the literature uses odds ratio(OR)and 95%confidence interval(CI)to represent it.If the outcome index is a numerical variable,the literature uses mean difference(MD)to represent it.(the inspection level of meta analysis is set asα=0.05).Results 1.A total of 392 relevant literatures were initially retrieved,duplicate literatures were excluded,irrelevant literatures were excluded after reading the titles and abstracts.After reading the full text,there were 9 randomized controlled literatures that met the inclusion criteria,including 8 in Chinese and 1 in English,including 874 subjects2.The results of meta-analysis showed that the 3-year survival rate and 5-year survival rate of concurrent radiotherapy and chemotherapy were significantly higher than those of sequential radiotherapy and chemotherapy(P<0.01).As for the toxicity and adverse reactions after postoperative adjuvant therapy,the results of meta-analysis were not enough to prove that the incidence of bone marrow suppression,gastrointestinal reaction and radiation proctitis in the synchronous radiotherapy and chemotherapy group was higher than that in the sequential radiotherapy and chemotherapy group,and the difference was not statistically significant(P>0.05).Conclusion Compared with the sequential radiotherapy and chemotherapy group,the3-year and 5-year survival rates of patients in the synchronous radiotherapy and chemotherapy group were higher,and the difference was statistically significant.There was no significant difference in bone marrow suppression,gastrointestinal reaction and radiation proctitis between the two groups,but the quantity and quality of the literature included in this study were low,and larger sample size and higher quality randomized controlled trials were needed for further analysis and research. |
