新辅助化疗治疗进展期胃癌疗效的Meta分析

Clinical Efficacy of Neoadjuvant Chemotherapy on the Treatment of Advanced Gastric Cancer:A Meta Analysis

目的:评价新辅助化疗在治疗进展期胃癌中的疗效及安全性。方法:采用Cochrane系统评价方法,检索Cochrane图书馆临床对照试验库,PubMed,Embase,Web of Knowledge,Elsevier,CBM数据库,CDDB及CNKI数据库,根据纳入和剔除标准选取文献,采用改良Jadad量表对纳入文献进行质量评价,应用Revman5.0软件对各评价指标进行Meta分析。结果:共纳入8项随机对照临床研究,研究对象1 531例。新辅助化疗组与单纯手术组在5年生存率、R0切除率方面比较,差异有统计学意义(P<0.05),其OR值分别为1.44(1.13-1.83,P=0.003)、1.44(1.11-1.88,P=0.006),而两组围手术期死亡率及术后并发症发生率比较,差异无统计学意义(P>0.05),其OR值分别为1.06(0.57-1.96,P=0.86)、1.20(0.90-1.61,P=0.22)。结论:新辅助化疗有利于提高进展期胃癌患者R0切除率,延长总生存期,且耐受性和安全性良好。

Objective：To evaluate the clinical efficacy of neoadjuvant chemotherapy for advanced gastric cancer.Methods：Electronic databases of Cochrane Library,PubMed,Embase,Web of Knowledge,Elsevier,CBM,CDDB and CNKI were systematically searched,screened according to preset inclusion and exclusion criteria,and evaluated by modified Jadad scale standard.Revman software（version 5.0）was used to undertake Meta analysis for evaluating the survival data,R0 resection rate,postoperative complications,and perioperative mortality.Results：Eight randomized,controlled trials with 1 531 patients were included in this study,including 724 patients with neoadjuvant chemotherapy and 807 patients with surgery treatment alone.Odds ratio（95%confidence interval,P-value）,expressed as neoadjuvant chemotherapy and surgery versus surgery alone,was 1.44（95% CI：1.13-1.83,P=0.003）for 5year overall survival,1.44（95% CI：1.11-1.88,P=0.006）for R0 resection,1.06（95% CI：0.57-1.96,P=0.86）for perioperative mortality,and 1.20（95% CI：0.90-1.61,P =0.22）for postoperative complications.Conclusion：Compared with surgery alone,neoadjuvant chemotherapy followed by surgery couldimprove survival and R0 resection rate without increasing adverse events in patients with advanced gastric cancer.