吉西他滨治疗复发转移性晚期鼻咽癌的系统评价

A Systematic Review of Gemcitabine for the Treatment of Advanced Nasopharyngeal Carcinoma

目的评价吉西他滨在晚期鼻咽癌治疗中的临床疗效,一线及二线治疗中的地位。方法采用Cochrane系统评价方法,检索Cochrane图书馆临床对照试验数据库、MEDLINE、EMBASE、OVID、CBM、CNKI和EBSCO等电子数据库。检索时间截至2008年3月。由2名评价者独立评价并交叉核对纳入研究质量,对同质研究采用RevMan4.2.8软件进行分析。结果共纳入8个研究,482例晚期鼻咽癌患者。分析结果表明,GP方案(吉西他滨+顺铂)与FP方案(氟尿嘧啶+顺铂)的1年生存率、3年生存率相似,但GP方案具有更高的总缓解率[相对危险度1.13,95%可信区间(1.02,1.25),P=0.02];GP方案(吉西他滨+顺铂)比GEM(单药吉西他滨)有更高的缓解率[相对危险度1.81,95%可信区间(1.06,3.08),P=0.03]和1年生存率[相对危险度1.78,95%可信区间(1.03,3.06),P=0.04],但3年生存率相似;GEM+CBP方案(吉西他滨联合卡铂)与DOC+DDP方案(紫杉醇联合顺铂)相比,具有更高的缓解率P<0.01;吉西他滨不同的给药方式比较,动脉灌注的缓解率(P=0.013)、1年生存率(P=0.018)、中位生存时间均(P=0.013)高于静脉滴注。结论吉西他滨治疗晚期鼻咽癌有确切临床疗效,无论是单药还是与其他药物的联合用药均具有与当前一线经典方案相当的疗效。

Objective To evaluate the role of Gemcitabine in the treatment of advanced nasopharyngeal carcinoma （NPC）.nethods Up to 2008, we searched the Cochrane Library, MEDLINE, EMBASE, OVID, CBM, CNKI, and EBSCO. The quality of included studies was evaluated and analyses were performed for the results of homogeneous studies by RevMan 4.2.8 software. Results 8 studies involving 482 participants with NPC were included. Analyses showed that 1 and 3 year survival rate of GP （Gemcitabine ＋ Cisplatin） regimen had no significant difference compared with FP regimen （Fluorouracil ＋ Cisplatin）, but had higher remission rate [RR=1.13, 95%CI（1.02,1.25） P=0.02]; The response rate and 1 year survival rate of GP （Gemeitabine ＋ Cisplatin） regimen was higher than that of monotherapy with Gemcitabine [RR=1.81, 95%CI（1.06,3.08）, P=0.03] , [RR=1.78, 95%CI（1.03,3.06）, P=0.04], but it had no significant difference between the two regimens in 3 year survival rate; the remission rate of GEM＋CBP （Gemcitabine ＋ Carboplatin） regimen was significant higher compared with DOC ＋ DDP regimen （Paclitaxel ＋ Cisplatin） （P〈0.01）. Compared with different mode of administration, there is higher response rate（P=0.013）, 1 year survival rate （P=0.018）, and longer median survival time（P=0.013） when Gemcitabine was administered by artery than venous. Conclusions Gemcitabine is an effective agent for NPC whatever used as monotherapy or combined treatment.