替吉奥单药及联合吉西他滨对比吉西他滨单药治疗晚期胰腺癌的系统评价

Systematic review of S-1 monotherapy and combined with gemcitabine versus gemcitabine for advanced pancreatic cancer

目的比较替吉奥(S-1)单药及联合吉西他滨(GS)与吉西他滨(GEM)单药治疗晚期胰腺癌患者的疗效与安全性差异。方法计算机检索CNKI、PubMed、Embase和Cochrane Library等数据库,纳入随机对照试验,采用Cochrane系统评价方法进行评价。结果纳入19个研究,共2 538例患者。在疗效上,S-1单药和GS方案均较GEM单药提高了晚期胰腺癌患者的治疗有效率、疾病控制率,而GS方案延长了患者的中位无进展生存期和中位总体生存期;安全性方面,血液学毒副作用GS方案较GEM单药发生率有所升高,而S-1单药发生率低于GEM单药;非血液学毒副作用,S-1单药和GS方案均较GEM单药无较大差异。结论晚期胰腺癌患者选择用药方案时,当患者血常规正常并可耐受情况下,可推荐使用GS方案;相反,则可推荐使用S-1单药。

Objective To compare the efficacy and safety of tegafur(S-1) monotherapy or combined with gemcitabine(GS) with gemcitabine(GEM) monotherapy in the treatment of patients with advanced pancreatic cancer.Methods Systematic searches were performed for randomized controlled trials with the CNKI,PubMed,Embase and Cochrane Library.Results Ninteen citations containing 2,538 patients with advanced pancreatic cancer met the selection criteria.Compared with GEM monotherapy,S-1 monotherapy/GS combination therapy improved the treatment efficiency and disease control rate,and GS ombination therapy extended the median progression-free survival and median overall survival of patients.As for the incidence of hematologic side effects,the GS ombination therapy was higher than GEM monotherapy,while that S-1 monotherapy was lower.There is no significant difference between S-1 monotherapy/GS ombination therapy with GEM monotherapy in the incidence of non-hematologic side effects.Conclusion For patients with advanced pancreatic cancer,GS ombination therapy is considered as the first-choice under the condition of patients with normal blood routine examination and well drug tolerance.Otherwise,S-1 monotherapy is recommend.