Chemotherapy in advanced gastric cancer: A systematic review and meta-analysis based on aggregate data
Chemotherapy in advanced gastric cancer: A systematic review and meta-analysis based on aggregate data
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DOI：
10.1200/jco.2005.05.0245
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发表时间：
2006-06-20
影响因子：
45.3
通讯作者：
Fleig, Wolfgang E.
中科院分区：
文献类型：
--
作者：
Wagner, Anna D.;Grothe, Wilfried;Fleig, Wolfgang E.
目的本系统评价和荟萃分析进行评估的疗效和耐受性的化疗患者进展期gastric cancer.Methods随机II期和III期临床试验的一线化疗在进展期gastric cancer. Methods确定的Medline，Embase，科克伦对照试验登记册，和Cancerlit的电子搜索，相关的摘要书籍和参考文献列表的手搜索，并与专家联系。采用固定效应模型进行Meta分析。总生存率，报告为风险比（HR）与95%CI，是主要的结局指标。（HR = 0.39; 95% CI，0.28 - 0.52）和联合与单药，主要是基于氟尿嘧啶（FU）的化疗（HR = 0.83; 95%CI = 0.74 - 0.93）显示化疗和联合化疗分别有利于显著的总生存期获益。此外，FU/含顺铂方案联合与不联合蒽环类药物（HR = 0.77; 95% CI，0.62 - 0.95）和FU/含蒽环类药物联合与不联合顺铂（HR = 0.83; 95% CI，0.76 - 0.91）的比较均证明了三药联合的显著生存获益。比较含伊立替康与非伊立替康的组合（主要是FU/顺铂）导致在一个非显着的生存获益，有利于含伊立替康的方案（HR = 0.88; 95%CI，0.73至1.06），但他们从来没有被比较对三种药物combination.Conclusion最好的生存结果与三种药物方案，含FU，蒽环类抗生素，顺铂。其中，包括FU作为推注的方案比使用FU连续输注的方案（如表阿霉素、顺铂和连续输注FU）显示出更高的毒性死亡率。
Purpose This systematic review and meta-analysis were performed to assess the efficacy and tolerability of chemotherapy in patients with advanced gastric cancer.Methods Randomized phase II and III clinical trials on first-line chemotherapy in advanced gastric cancer were identified by electronic searches of Medline, Embase, the Cochrane Controlled Trials Register, and Cancerlit; hand searches of relevant abstract books and reference lists; and contact to experts. Meta-analysis was performed using the fixed-effect model. Overall survival, reported as hazard ratio (HR) with 95% CI, was the primary outcome measure.Results Analysis of chemotherapy versus best supportive care (HR = 0.39; 95% CI, 0.28 to 0.52) and combination versus single agent, mainly fluorouracil (FU) -based chemotherapy (HR = 0.83; 95% CI = 0.74 to 0.93) showed significant overall survival benefits in favor of chemotherapy and combination chemotherapy, respectively. In addition, comparisons of FU/cisplatin-containing regimens with versus without anthracyclines (HR = 0.77; 95% CI, 0.62 to 0.95) and FU/anthracycline-containing combinations with versus without cisplatin (HR = 0.83; 95% CI, 0.76 to 0.91) both demonstrated a significant survival benefit for the three-drug combination. Comparing irinotecan-containing versus nonirinotecan-containing combinations (mainly FU/cisplatin) resulted in a nonsignificant survival benefit in favor of the irinotecan-containing regimens (HR = 0.88; 95% CI, 0.73 to 1.06), but they have never been compared against a three-drug combination.Conclusion Best survival results are achieved with three-drug regimens containing FU, an anthracycline, and cisplatin. Among these, regimens including FU as bolus exhibit a higher rate of toxic deaths than regimens using a continuous infusion of FU, such as epirubicin, cisplatin, and continuous-infusion FU.