替吉奥对比卡培他滨治疗胃肠道肿瘤的系统综述和meta分析

S-1 Versus Capecitabine in Treatment of Gastrointestinal Cancer: A Systematic Review and Meta-analysis

背景:替吉奥和卡培他滨同属于第三代口服氟尿嘧啶类化疗药物,在胃肠道肿瘤治疗中被广泛使用。近年关于两者临床疗效和安全性的研究虽多,但结果不一。目的:比较替吉奥与卡培他滨用于治疗胃肠道肿瘤的疗效和安全性。方法:在PubMed、Embase、Web of Science和Cochrane Library中检索对比替吉奥与卡培他滨治疗胃癌和结直肠癌的英文文献,对各研究进行系统综述并应用RevMan 5.3软件进行meta分析。结果:根据设置的标准共13篇文献纳入分析,包括3 540例患者。Meta分析结果显示,在胃癌和结直肠癌患者中,替吉奥与卡培他滨的总有效率(ORR)、疾病控制率(DCR)、总生存期(OS)差异均无统计学意义(ORR: OR=0.97, 95% CI: 0.67~1.39, P =0.86;DCR: OR=1.15, 95% CI: 0.74~1.79, P =0.52;OS: HR=0.96, 95% CI: 0.91~1.01, P =0.15);按肿瘤部位进行亚组分析,结果不变。在无进展生存期(PFS)方面,替吉奥在患者总体和结直肠癌患者中优于卡培他滨(总体:HR=0.94, 95% CI: 0.89~0.98, P =0.008;结直肠癌:HR=0.93, 95% CI: 0.88~0.98, P =0.004)。替吉奥手足综合征发生率显著低于卡培他滨(3-4级:OR=0.07, 95% CI: 0.04~0.13, P =0.000),但3-4级白细胞减少、便秘、腹泻发生率高于卡培他滨。结论:临床治疗胃和结直肠癌时,以替吉奥为基础的化疗方案可作为一种优选方案。

Background: S-1 and capecitabine are both the third generation oral fluoropyrimidine commonly used in the chemotherapy of gastrointestinal cancer. Numerous studies compared the efficacy and safety between these two drugs, but the results were not consistent. Aims: To compare the efficacy and safety of S-1 versus capecitabine in treatment of gastrointestinal cancer. Methods: A systematic literature review was conducted for clinical studies (in English) retrieved from PubMed, Embase, Web of Science and Cochrane Library. A meta-analysis was performed in eligible randomized controlled trials and retrospective studies comparing S-1 versus capecitabine for chemotherapy of gastric cancer and colorectal cancer using RevMan 5.3 software. Results: Thirteen studies with 3 540 gastric and colorectal cancer patients were identified for meta-analysis. In gastrointestinal cancer patients, the overall response rate (ORR), disease control rate (DCR) and overall survival (OS) of S-1 were not inferior to those of capecitabine (ORR: OR=0.97, 95% CI: 0.67- 1.39, P =0.86;DCR: OR=1.15, 95% CI: 0.74-1.79, P =0.52;OS: HR=0.96, 95% CI: 0.91-1.01, P = 0.15 );subgroup analysis according to tumor location showed the same results. But for progression-free survival (PFS), S-1 was superior to capecitabine in overall patients (HR=0.94, 95% CI: 0.89-0.98, P =0.008) and those with colorectal cancer (HR=0.93, 95% CI: 0.88-0.98, P =0.004). Meta-analysis for adverse events indicated lower incidence of hand-food syndrome (grade 3-4: OR=0.07, 95% CI: 0.04-0.13, P =0.000), and higher incidence of grade 3-4 leukopenia, constipation and diarrhea in S-1-based arm. Conclusions: S-1-based therapy might be recommended as a preferred alternative for fluoropyrimidine-based chemotherapy of gastric and colorectal cancer.