进展期胃癌新辅助化疗疗效评价:16个随机试验的荟萃分析

The Efficiency of Neoadjuvant Chemotherapy for Advanced Gastric Cancer:A Meta-Analysis of 16 Randomized Clinical Trials

[目的]评价新辅助化疗（neoadjuvant chemotherapy,NAC）在进展期胃癌中的安全性和有效性。[方法]在Pubmed、Cochrane library和EMbase等数据库中检索1990年1月至2015年9月发表的有关NAC的随机对照试验（randomized controlled trials,RCTs）,由两位独立的研究人员进行文献筛选和数据提取。采用Rev Man 5.3软件进行荟萃分析。[结果]共纳入16项RCTs,共2077例患者（NAC组308例,对照组316例）。结果显示NAC较对照组能提高进展期胃癌的总体生存率（HR=0.74,95%CI：0.63-0.88,P=0.0006）、5年生存率（OR=1.61,95%CI：1.24-2.09,P=0.0004）和3年无病生存期（HR=0.66,95%CI：0.56-0.77,P0.05）差异无统计学意义。[结论 ]NAC能提高进展期胃癌患者的生存率,提高手术切除率,降低肿瘤分期。其安全可行,患者可耐受。

[Purpose] To evaluate the safety and efficacy of neoadjuvant chemotherapy（NAC） for advanced gastric cancer（AGC）. [Methods] Electronic databases（Pub Med,Embase,Cochrane Library） and ASCO proceedings from 1990 to 2015 was searched,all randomized controlled trails（RCTs） which compared the effect of NAC combined surgery versus surgery alone in gastric cancer would be included. All calculations and statistical tests were performed using Rev Man 5.3 software. [Results] Sixteen RCTs with a total of 2077 patients were included. NAC can improve the overall survival（OS）（HR=0.74,95%CI：0.63-0.88,P=0.0006）,the 5-year survival rate（OR=1.61,95%CI：1.24 -2.09,P =0.0004） and the 3-year progression-free survival（PFS）（HR =0.66,95% CI：0.56 -0.77,P〈0.00001）,tumor down-staging rate（OR=1.71,95%CI：1.26-2.33,P=0.0006） and R0 resection rate（OR=1.55,95%CI：1.22-1.97,P=0.0003） of patients with AGC. There were no difference in terms of postoperative complications（OR=1.12,95%CI：0.87-1.44,P=0.40）,perioperative mortality（OR =1.14,95% CI：0.64 -2.05,P =0.65） and grade 3/4 adverse effects（P 〉0.05） between the two groups. [Conclusions] NAC can significantly improve the survival of patients with AGC. It is safe and feasible,and can be tolerated.