胃癌D2根治术后同期放化疗与化疗的疗效及毒副反应的Meta分析

Postoperative chemoradiotherapy versus postoperative chemotherapy for gastric cancer with concurrent completely resected D2 lymphadenectomy: a Meta-analysis of the efficacy and toxic-side effects

目的评价胃癌D2根治术后同期放化疗与化疗的疗效及毒副反应。方法计算机检索2013年10月之前纳入Cochrane library图书馆、Embase数据库、Pub Med数据库、Web of Science数据库、Wanfang数据库、CNKI数据库中比较胃癌D2根治术后同期放化疗与化疗的随机对照（RCT）研究。依据数据同质性或异质性确定数据使用固定效应模型或随机效应模型。使用Rev Man 5.2软件进行数据分析,两组之间的差异用OR值和95%CI描述。结果共纳入5个RCT研究,总计979例患者。通过Meta分析得出：胃癌D2根治术后同期放化疗与化疗相比,放化疗显著提高了5年局部无复发生存率（LRRFS）及3年总生存率（OS）,但不能提高5年无远处复发生存率（DMRFS）及1年、3年、5年无病生存率（DFS）和1年、5年OS;且拥有和化疗同样的1~2级、3~4级恶心呕吐不良反应及1~2级、3~4级白细胞毒性反应。结论今后研究应依据胃癌的分期、种族、淋巴结转移及淋巴结清扫数目来确定胃癌D2根治术术后同期放化疗与化疗。

Objective To investigate the efficacy and toxic-side effects of postoperative chemoradiotherapy and postop- erative chemotherapy for gastric cancer with concurrent completely resected D2 lymphadenectomy. Methods All RCTs that compared postoperative chemoradiotherapy with postoperative chemotherapy for gastric cancer with concurrent com- pletely D2 lymphadenectomy resected were included in the Meta-analysis. A systematic research of relevant studies pub- lished through Oct. 2013 was conducted using the Cochrane library databases, Embase, PubMed, Web of Science, Wan- fang and CNKI databases. Meta-analysis was performed by RevMan 5.2 software to obtain the relative hazards of adjuvant chemoradiotherapy to chemotherapy on efficacy and toxic-side effects. Odds ratios （ORs） and 95% CI were calculated to estimate the association strength. Results A total of 979 patients from 5 RCTs were included. All patients were from Asi- an countries. Compared with chemotherapy, chemoradiotherapy significantly improved the survival rates of 5-year local re- gional relapse-free survival （LRRFS） and 3-year overall survive （OS） ; but did not improve the survival rate of 5-year dis- tant metastasis regional relapse-free survival （DMRFS）, 1-year, 3-year and 5-year disease free survival （DFS）, 1-year and 5-year OS, and had same risk of grade 1 - 2, grade 3 - 4 nausea and vomiting toxicities, grade 1 - 2, grade 3 - 4 neu- tropenia toxicities. Conclusion Further clinictrials depending on different tumor stage, race, lymph node metastasis, sweep lymph node numbers, receiving chemoradiotheraphy and chemotherapy with completely resected D2 lymphadenecto- my resected gastric cancer should be conducted.