替吉奥治疗晚期胃癌有效性和安全性的系统评价

Efficacy and safety of S-1 for advanced gastric cancer:a systematic review

目的:系统分析替吉奥治疗晚期胃癌的有效性、安全性,以期做出客观可信的评价,指导临床用药。方法:计算机检索Cochrane图书馆、MEDLINE、Elsevier、CNKI、中文生物医学会议文献数据库,纳入替吉奥或替吉奥联合铂类治疗晚期胃癌的随机或半随机对照试验(RTC),采用RevMan5.2软件进行方法学质量评价和统计分析。结果:纳入10个RTC,替吉奥可显著提高药物对晚期胃癌患者的病情控制率[OR=1.9,95%CI(1.27,2.85),P=0.002];联合胃癌术后给药与单独手术比较,替吉奥显著提高晚期胃癌患者三年存活率(P=0.000 2)和五年存活率(P=0.002);显著降低术后复发率;在药物安全性方面,替吉奥在治疗过程中能显著降低化疗引起的血液系统的严重不良反应,对降低消化系统严重不良反应(以呕吐腹泻为代表进行分析)和其他严重不良反应(以化疗性口腔炎为代表)方面无显著性差异。结论:与其他化疗药物比较,替吉奥治疗晚期胃癌总体疗效肯定,在有效缓解控制临床症状的同时能减轻患者血液系统方面的不良反应,改善患者生活质量;联合术后给药与单独手术比较,替吉奥能显著提高患者术后存活率,降低术后复发率,是治疗晚期胃癌的优选方案。

OBJECTIVE To assess the efficacy and safety of S-1 in treating advanced gastric cancer. METHODS The Co- chrane library, MEDLINE, Elsevier, CNKI databases were searched, randomized controlled trails（RCT） about S1 for advanced gastric cancer were evaluated and analyzed by RevMan5.2. RESULTS 10 RCTs were enrolled in the Meta-analysis. The S-1 group had a higher the disease control rate than the control group [OR = 1.9, 95 %CI（1.27,2. 85）, P = 0. 0021. Compared with the surgery-only group, the S-1 group had a higher rate of overall survival at 3 years （P = 0. 0002） and at 5 years （P = 0. 002） than in the surgery-only group. Significant safety advantages were observed in the 8-1 group, the hematological system （ grade 3/4） in the incidence of adverse reactions significant decreased comparing with the control group. There were no significant differences at digestive system, stomatitis in the incidence of adverse reactions. CONCLUSION S-1 showed good efficacy in the treatment advanced gastric carcinoma, and the adverse reactions were relatively mild. So S1 is the better choice for the treat- ment of advanced gastric cancer.