Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer.
Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer.
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DOI：
10.1038/sj.bjc.6602513
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发表时间：
2005-04-25
影响因子：
8.8
通讯作者：
中科院分区：
文献类型：
--
作者：
本研究的目的是调查全球范围内的证据，辅助放化疗和辅助化疗的作用，对生存的潜在治愈切除胰腺癌。确定了5项在组织学证实的胰腺导管腺癌患者中进行辅助治疗的随机对照试验，其中4项最近的试验提供了个体患者数据（875例患者）。该荟萃分析包括261例患者的既往未发表的随访数据。风险比（HR）的汇总估计值表明，化疗可使死亡风险显著降低25（HR=0.75，95%置信区间（CI）：0.64，0.90，分层P值（Pstrat）=0.001），中位生存期估计为19.0（95% CI：16.4，21.1）个月，未化疗13.5（95% CI：12.2，15.8）个月。2年和5年生存率估计分别为38%和19%，化疗和28%和12%，没有。HR的汇总估计值表明，放化疗组的死亡风险无显著差异（HR=1.09，95% CI：0.89，1.32，Pstrat=0.43），放化疗组的中位生存期估计为15.8（95% CI：13.9，18.1）个月，不放化疗组为15.2（95% CI：13.1，18.2）个月。2年和5年生存率估计分别为30%和12%，放化疗和34%和17%，没有。亚组分析估计，在切缘阳性的患者中，放化疗更有效，化疗效果较差。这些结果表明，化疗是有效的辅助治疗胰腺癌，而不是放化疗。对于切缘阳性的患者，进一步的放化疗研究是必要的，因为化疗在这个患者亚组中相对无效。
The aim of this study was to investigate the worldwide evidence of the roles of adjuvant chemoradiation and adjuvant chemotherapy on survival in potentially curative resected pancreatic cancer. Five randomised controlled trials of adjuvant treatment in patients with histologically proven pancreatic ductal adenocarcinoma were identified, of which the four most recent trials provided individual patient data (875 patients). This meta-analysis includes previously unpublished follow-up data on 261 patients. The pooled estimate of the hazard ratio (HR) indicated a 25% significant reduction in the risk of death with chemotherapy (HR=0.75, 95% confidence interval (CI): 0.64, 0.90, P-valuesstratified (Pstrat)=0.001) with median survival estimated at 19.0 (95% CI: 16.4, 21.1) months with chemotherapy and 13.5 (95% CI: 12.2, 15.8) without. The 2- and 5-year survival rates were estimated at 38 and 19%, respectively, with chemotherapy and 28 and 12% without. The pooled estimate of the HR indicated no significant difference in the risk of death with chemoradiation (HR=1.09, 95% CI: 0.89, 1.32, Pstrat=0.43) with median survivals estimated at 15.8 (95% CI: 13.9, 18.1) months with chemoradiation and 15.2 (95% CI: 13.1, 18.2) without. The 2- and 5-year survival rates were estimated at 30 and 12%, respectively, with chemoradiation and 34 and 17% without. Subgroup analyses estimated that chemoradiation was more effective and chemotherapy less effective in patients with positive resection margins. These results show that chemotherapy is effective adjuvant treatment in pancreatic cancer but not chemoradiation. Further studies with chemoradiation are warranted in patients with positive resection margins, as chemotherapy appeared relatively ineffective in this patient subgroup.
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影响因子：
8.8
作者：
Peto R;Pike MC;Armitage P;Breslow NE;Cox DR;Howard SV;Mantel N;McPherson K;Peto J;Smith PG
通讯作者：
Smith PG
影响因子：
8.4
作者：
BAKKEVOLD, KE;ARNESJO, B;KAMBESTAD, B
通讯作者：
KAMBESTAD, B
影响因子：
9
作者：
Neoptolemos, JP;Stocken, DD;Büchler, MW
通讯作者：
Büchler, MW
影响因子：
9
作者：
Klinkenbijl, JH;Jeekel, J;Wils, J
通讯作者：
Wils, J
影响因子：
6.2
作者：
Takada, T;Amano, H;Nakayama, T
通讯作者：
Nakayama, T