Which is better for gastric cancer patients, perioperative or adjuvant chemotherapy: a meta-analysis.
Which is better for gastric cancer patients, perioperative or adjuvant chemotherapy: a meta-analysis.
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DOI：
10.1186/s12885-016-2667-5
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发表时间：
2016-08-12
期刊：
影响因子：
3.8
通讯作者：
Wang ZN
中科院分区：
文献类型：
--
作者：
Zhao JH;Gao P;Song YX;Sun JX;Chen XW;Ma B;Yang YC;Wang ZN
胃癌的首选化疗方法仍然是一个有争议的问题。我们进行了一项荟萃分析，比较围手术期化疗和辅助化疗的预后和安全性，以确定更好的胃癌化疗方案。截至2016年2月，我们检索了PubMed、EMBASE、Cochrane Library和Ovid数据库，寻找符合条件的研究。主要终点为预后价值（总生存率[OS]的风险比[HR]和1、2、3、5年生存率）、化疗有效率、根治性切除率、术后并发症发生率、化疗不良反应。5项随机对照试验和6项临床对照试验纳入1240例患者。与辅助化疗组相比，围手术期化疗组预后明显更好（HR为0.74；95% CI为0.61 ~ 0.89;P < 0.01）。在联合化疗作为新辅助化疗方案的研究中，两组之间的差异仍然显著（HR, 0.59; 95% CI, 0.46 ~ 0.76; P < 0.01），而在氟嘧啶单药治疗的研究中，两组之间的差异不显著（HR, 0.93; 95% CI, 0.56 ~ 1.55; P = 0.84）。两组术后并发症发生率（相对危险度0.98;95% CI 0.63 ~ 1.51; P = 0.91）和化疗不良反应（所有不良反应P < 0.05）差异均无统计学意义。与辅助化疗相比，围手术期化疗可提高胃癌患者的生存率。此外，在新辅助化疗方案中，联合化疗比单一化疗的生存率更高。本文的在线版本（doi:10.1186/s12885-016-2667-5）包含补充材料，可供授权用户使用。
The preferred chemotherapy method for gastric cancer continues to be matter of debate. We performed a meta-analysis to comparing prognosis and safety between perioperative chemotherapy and adjuvant chemotherapy to identify the better chemotherapy option for gastric cancer. We searched the PubMed, EMBASE, Cochrane Library, and Ovid databases for eligible studies until February 2016. The main endpoints were prognostic value (hazard ratio [HR] for overall survival [OS] and 1-, 2-, 3-, and 5-year survival rate), response rate of chemotherapy, radical resection rate, post-operative complication rate, and adverse effects of chemotherapy. Five randomized controlled trials and six clinical controlled trials involving 1,240 patients were eligible for analysis. Compared with the adjuvant chemotherapy group, the perioperative chemotherapy group had significantly better prognosis (HR, 0.74; 95 % CI, 0.61 to 0.89; P < 0.01). The difference between the two groups remained significant in the studies that used combination chemotherapy as the neoadjuvant chemotherapy regimen (HR, 0.59; 95 % CI, 0.46 to 0.76; P < 0.01) but were not significant in the studies that used fluoropyrimidine monotherapy (HR, 0.93; 95 % CI, 0.56 to 1.55; P = 0.84). Furthermore, the two groups showed no significant differences in the post-operative complication rates (relative risk, 0.98; 95 % CI, 0.63 to 1.51; P = 0.91) or adverse effects of chemotherapy (P > 0.05 for all adverse effects). Perioperative chemotherapy showed improved survival compared to adjuvant chemotherapy for gastric cancer. In addition, combination chemotherapy resulted in better survival compared to monotherapy in the neoadjuvant chemotherapy regimens. The online version of this article (doi:10.1186/s12885-016-2667-5) contains supplementary material, which is available to authorized users.