目的 评价对符合WHO最新诊断标准的高级别脑胶质细胞瘤患者实施化疗的疗效.方法 通过电子检索及手工检索尽可能收集高级别脑胶质细胞瘤化疗的高质量随机对照临床试验,进行系统评价.结果 本研究共纳入4篇随机对照试验,均为高质量研究."倒漏斗"图显示基本对称图形,表明无发表偏倚,本研究结论较为可靠.结果 表明,化疗可明显增加脑胶质细胞瘤患者1～3年的无进展生存率,合并OR值分别为2.36(95%CI 1.22～4.56,P=0.01),1.97(95%CI 1.06～3.66,P=0.03),1.88(95%CI 1.23～2.86,P=0.003);但不增加1～3年的总生存率,合并OR值分别为1.51(95%CI 0.73～3.11,P=027),1.45(95%CI 0.76～2.76,P=0.25),1.99(95%CI 0.43～9.27,P=0.38).结论 由于所收集文献的研究对象来自不同的种族、人群,受到多种因素的影响,故成人高级别脑胶质细胞瘤化疗疗效还有待于组织大规模、多中心的临床研究来进一步论证.%Objective To assess the effectiveness of chemotherapy in adult patients with high-grade glioma with Meta-analysis. Methods Electronic and manual searches were conducted to acquire all randomized controlled trials (RCT) on chemotherapy for adult high-grade glioma. And trials were considered high quality if methodological quality score was 3 or more according jaded standard. And then the trials were assessed systematically. Results Four RCTs including 1340 patients were analyzed. Inspection of the funnel plots for all outcome measurements did not reveal evidence of publication bias. The results indicated that chemotherapy might significantly prolong the 1-3 year of disease-free survival (DFS) and the total OR values were 2.36 ( 95％CI 1.22 ～ 4.56,P= 0.01 ), 1.97 ( 95％CI 1.06 ～ 3.66,P= 0.03 ), 1.88 ( 95％CI 1.23 ～ 2.86,P= 0.003 ), respectively; but it did not prolong the 1-3 year overall surviva(OS), and the total OR values were 1.51 ( 95CI 0.73 ～ 3.11, P= 0.27 ), 1.45( 95CI 0.76 ～ 2.76,P=0.25 ),1.99 ( 95CI 0.43 ～ 9.27,P= 0.38 ), respectively. Conclusion The results of this Meta-analysis would be affected by race differences and other factors involved in the clinical trials; large scale, multi-center, randomized trials are needed for further analysis on the effectiveness and safety of chemotherapy for high-grade glioma.
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