吉西他滨联合化疗一线治疗晚期胰腺癌生存结果亚组meta分析.docVIP

吉西他滨联合化疗一线治疗晚期胰腺癌生存结果亚组meta分析 　 作者：谢德荣 梁汉霖 杨琼 江志敏 郭双双 陈邓林 毕卓菲 【摘要】 【目的】 Meta分析提示吉西他滨（GEM）联合化疗一线治疗晚期胰腺癌优于标准的GEM单药化疗，在此基础上进行亚组生存结果的meta分析及资料更新，旨在寻找确切有效的化疗方案。【方法】通过MEDLINE、EMBASE、ASCO、ECCO等数据库及论文集检索相关文献。按纳入标准筛选新增文献并进行资料更新。主要对各亚组进行半年生存率、其次是1年生存率的meta分析。【结果】 17个随机对照临床试验（RCT）共3 821例患者纳入分析，按化疗方案分为GEM联合顺铂（GEMDDP）、GEM固定剂量率输注联合奥沙利铂（GEMOX）、联合5FU（GEMFU）、联合卡培他滨（GEMCAP）以及联合伊立替康（GEMIRI）等5个亚组，各亚组半年生存率的治疗优势（RD）分别为5%（P=0.24）、9%（P=0.005）、2%（P=0.46）、7%（P=0.03）和-1%（P=0.88）；1年生存率RD为6%（P=0.11）、5%（P=0.07）、4%（P=0.19）、5%（P=0.08）和0（P=0.97）。【结论】现有的证据提示GEMOX、GEMCAP联合化疗方案一线治疗晚期胰腺癌，有较好的应用前景，值得进一步的临床试验。 【关键词】 胰腺肿瘤； 化学疗法； 吉西他滨； 卡培他滨； 奥沙利铂； Meta分析 Abstract:【Objective】 Previous meta-analyses had shown gemcitabie (GEM)-based combination chemotherapy was superior to GEM monotherapy for advanced pancreatic cancer (APCa), Subgroup analyses were performed using updated information to seek for the exactly effective GEM-based combination regimen to benefit patients with APCa. 【Methods】 Subgroup meta-analyses of all previously published or unpublished studies were performed with a comprehensive search of the updated literature including MEDLINE, EMBASE, ASCO and ECCO. The analyses included all randomized evidence to compare GEM combination chemotherapy with GEM alone with respect to 6-month survival rate (6-mo SR) and 1-year survival rate (1-y SR) in APCa patients. 【Results】 Seventeen RCTs involving 3821 patients were included in this meta-analysis, which were divided into five subgroups according to the combination chemotherapy regimen, GEM plus cisplatin (GEMDDP), fixed-dose rate infusion of GEM plus oxaliplatin (GEMOX), GEM plus 5-fluorouracil (GEMFU), GEM plus capecitabine (GEMCAP) and GEM plus irinotecan (GEMIRI). Subgroup analyses showed the risk difference (RD) of 6-mo SR were 5% (P=0.24), 9% (P=0.005), 2% (P=0.46), 7% (P=0.03) and -1% (P=0.88), respectively; and the 1-y SR 6% (P=0.11), 5% (P=0.07), 4% (P=0.19), 5% (P=0.08), and 0% (P=0.97), respectively. 【Conclusion】 Based on the available evidence