姑息化疗和最佳支持治疗在晚期胰腺癌中的比较

A comparison of 5-FU-based chemotherapy with best supportivecare in inoperable pancreatic cancer

目的评价姑息化疗在提高晚期胰腺癌病人生存期方面的意义,本文所指的姑息化疗均是以5鄄FU为基础的。方法通过MEDLINE、EMBASE等数据库检索国内外已发表和未发表的相关文献。选择治疗组为姑息化疗并对症支持治疗,对照组为只给予对症支持治疗的晚期胰腺癌的随机对照试验。由2位评价者分别按上述检索策略收集资料,按选择标准入选,主要对半年生存率及1年生存率进行Meta分析。结果姑息化疗与最佳支持治疗对比,治疗晚期胰腺癌使半年生存率提高21%,使1年生存率提高6%,但均无统计学意义。结论目前姑息化疗可以选择性地用于晚期胰腺癌,部分病人可能获益,但仍不能作为标准治疗。

Objectives To evaluate chemotherapy effects on survival in patients with inoperable pancreatic cancer. Methods MEDLINE and EMBASE searches were supplemented by information from trial registers. RCT(rando-mized clinical trial) for 5-FU-based chemotherapy and best supportive care in inoperable pancreatic cancer. A quantitative meta-analysis,using updated information based on inclusion and exclusion criteria from all available RCT,was carried out by two reviewers. The meta-analysis was based on 6 months' survival and 1 year's survival. Results 21% relative increase was obtained in patients with inoperable pancreatic cancer treated by 5-FU-based chemotherapy compared with best supportive care on 6 months' survival. And 6% relative increase was obtained in patients with inoperable pancreatic cancer treated by 5-FU-based chemotherapy compared with best supportive care on 1 year's survival. Both of the results have no significant statistical difference. Conclusion There is no convincing evidence that a large fraction of inoperable pancreatic cancer patients will benefit from intravenous 5-FU-based chemotherapy. Intravenous 5-FU-based chemotherapy in inoperable pancreatic cancer can only be recommended selectively and should preferably be used within controlled clinical trials. Trying to resolve the problem,we should perform a series of controlled, prospective, randomized, double-blind, well-designed, multi-center trials.