胃癌根治术后静脉化疗效果的系统评价

Intravenous Chemotherapy for Curative Gastrectomy for Gastric Carcinomas:A Collective Review of Randomized Controlled Trials.

目的:评价胃癌根治术后接受不同药物、剂量(经静脉)化疗的疗效和安全性。方法:应用国际Cochrane协作网的系统评价方法,研究文献中关于胃癌根治术后接受不同药物、剂量(经静脉)化疗组与单纯根治手术组疗效比较的随机和半随机试验进行了系统评价。结果:17个试验包括2915例病人,经异质性检验,χ2=37.58,P=0.0017,17个试验存在异质性;采用随机效应模型(D鄄L)法进行meta分析,合并效应量OR=0.66,95%可信区间为0.51～0.85,经u检验,P=0.002,说明胃癌根治术后接受不同药物、剂量(经静脉)化疗组的疗效优于单纯根治手术组。17篇文章中有9篇对化疗药物的毒性反应按WHO分度标准进行描述,副作用主要有胃肠道症状、骨髓抑制、心脏毒性、血液毒性等,5例病人死于化疗相关毒性事件。结论:胃癌根治术后接受化疗可能有一定效果,毒性事件发生率较低;在接受根治性切除术后,全身静脉化疗对提高胃癌病人的5年生存率可能有一定的作用。

Objective:To assess the safety and effect of different intravenous chemotherapeutic regimens in patients with gastric carcinomas following curative gastrectomy.Methods:A systematic review of relevant randomized controlled trials(RCTs)was performed.RCTs were identified from Medline and Embase(1980～2002/8),and the Chinese Biomedicine Database(1990～2002/8).Literature references were checked at the same time.Randomized and quasirandomized trials with confirmed cases of curative gastrectomy were included,comparing the effect of curative gastrectomy followed by intravenous chemotherapy with that of gastrectomy alone.Results:Seventeen trials involving2915patients were included.Metaanalysis was done with random effects model.Heterogeneity and sensitivity analyses were performed also.The effect of curative gastrectomy intravenous chemotherapy combined with post-operative was better than surgery alone(odds ratio0.66,95%CI0.51～0.85).There was significant difference between the two groups by utest(P=0.002).Sensitivity analyses revealed the same difference(odds ratio0.79,95%CI0.64～0.98).There were nine trials which detailed the sideeffects by the WHO toxicity grade standard.The sideeffects were haematologic and biochemical toxicity,debilitating nausea and vomiting.There were five patients died of chemotherapeutic toxicity.Conclusions:Based on the present review,curative gastrectomy followed by post-operative intravenous chemotherapy produces a positive therapeutic effect on gastric cancer.