胃癌术后辅助放化疗与辅助化疗比较的荟萃分析

A meta-analysis of controlled clinical trials comparing postoperative adjuvant chemoradiotherapy with adjuvant chemotherapy in patients with gastric cancer

目的 采用偱证医学荟萃分析的方法比较胃癌术后辅助放化疗与辅助化疗间的疗效差异.方法 计算机检索PubMed、EMbase、Cochrane图书馆、万方、维普、CNKI及中国生物医学等数据库,搜集有关胃癌术后辅助放化疗和辅助化疗比较的临床对照研究资料,汇总数据采用RevMan5.2.5和Stata 12.0软件进行分析.两组间差异采用优势比（OR）及95％可信区间（95％CI）描述.结果 根据纳入和排除标准,最终纳入12个包括1674例患者的临床对照研究资料.荟萃分析结果显示,与胃癌术后辅助化疗相比,辅助放化疗的3、5年生存率更高（OR=2.96,95％ CI=1.75～5.03,P=0.000;OR=1.45,95％ CI=1.06～ 1.99,P=0.020）,辅助放化疗的局部复发率更低（OR=0.50,95％ CI =0.34 ～0.72,P=0.000）,但远处转移率两组相似（OR=0.79,95％ CI=0.58～1.07,P =0.130）.结论 现有研究结果的荟萃分析显示,与胃癌术后辅助化疗相比,胃癌术后辅助放化疗是一种较为安全和有效的治疗方法.

Objective To compare postoperative adjuvant chemoradiotherapy with adjuvant chemotherapy in patients with gastric cancer by a meta-analysis.Methods PubMed,EMbase,Cochrane Library,Wanfang,CNKI,VIP,and CBM databases were searched to identify the controlled clinical trials of postoperative adjuvant chemoradiotherapy versus adjuvant chemotherapy for gastric cancer.The obtained data were analyzed using RevMan 5.2.5 and Stata 12.0.The difference between two groups was estimated by calculating the odds ratio （OR） with 95% confidence interval （CI）.Results A total of 12 controlled clinical trials involving 1674 gastric cancer patients,which were selected according to inclusion and exclusion criteria,were included in this meta-analysis.The meta-analysis showed that the 3-and 5-year survival rates were significantly higher in the adjuvant chemoradiotherapy group than in the adjuvant chemotherapy group （OR=2.96,95% CI=1.75-5.03,P=0.000; OR=1.45,95% CI=1.06-1.99,P =0.020）;the local recurrence rate was significantly lower in the adjuvant chemoradiotherapy group than in the adjuvant chemotherapy group （OR =0.50,95% CI =0.34-0.72,P =0.000） ; there was no significant difference in distant metastasis rate between the two groups （OR =0.79,95% CI =0.58 -1.07,P =0.130）.Conclusions The meta-analysis of existing study results shows that compared with adjuvant chemotherapy alone,adjuvant chemoradiotherapy is a relatively safe and effective postoperative treatment for gastric cancer.