吉西他滨联合替吉奥与吉西他滨单药化疗治疗晚期胰腺癌比较的Meta分析

doi:10.3760/cma.j.issn.1673422X.2014.03.023

摘要/Abstract

摘要： 目的通过Meta分析，探讨吉西他滨(GEM)联合替吉奥（S-1）和GEM单药化疗在晚期胰腺癌治疗中的意义。方法计算机检索Pubmed、Cochrane Library、EMBASE、中国知网数据库、中国生物医学文献数据库，查找从数据库建库至2013年8月1日国内外已发表的相关文献。选择治疗组为GEM联合S1化疗，对照组为GEM单药化疗治疗晚期胰腺癌的随机对照试验。由两位评价者分别检索、收集资料，按纳入标准入选，主要分析指标为生存优势（包括生存率和疾病无进展生存率），次要分析指标为客观缓解率、疾病控制率和不良反应。结果共纳入3个随机对照试验。Meta分析显示GEM+S1联合化疗能明显延长患者的疾病无进展生存期（HR=0.64，95%CI为0.54～0.75，P＜0.000 01）及总生存期(HR=0.81,95%CI为0.68～0.96,P=0.01)，提高客观缓解率［风险差异（risk difference，RD）=0.16,95%CI为0.10～0.21,P＜0.000 01］及疾病控制率(RD=0.10,95%CI 0.03～0.17，P=0.009)，但同时3、4级不良反应也明显升高，中性粒细胞减少增加18%（P=0.02）、血小板减少增加6%（P=0.008）、胃肠道反应增加8%（P＜0.000 01）。结论GEM联合S1用于晚期胰腺癌患者疗效确有明显提高，虽不良反应也明显增加，但总体生存获益有所提高。

关键词: 胰腺肿瘤, 药物疗法, Meta分析, 吉西他滨

Abstract: ObjectiveTo compare the gemcitabine (GEM) plus S1 and gemcitabine alone in the treatment of advanced pancreatic cancer (PC) by metaanalysis. MethodsArticles were searched in PubMed, Cochrane library, Embase, CNKI, and CBM up to August 1st, 2013. Only randomized controlled trails (RCTs) for GEM+S1 and GEM alone in advanced PC were included. Two reviewers retrieved and collected data respectively. Data were selected basing on inclusion and exclusion criteria. The metaanalysis was base on survival advantage (include overall survival and progress free survival), object response rate, disease control rate and adverse reaction. ResultsA total of 3 trials with 772 cases were included. Metaanalysis demonstrated that GEM plus S1 significantly improved the progress free survival (HR: 0.64, 95%CI: 0.540.75, P<0.000 01) and overall survival (HR: 0.81, 95%CI: 0.680.96, P=0.01), improved object response rate (RD: 0.16, 95%CI: 0.100.21, P<0.000 01) and disease control rate (RD: 0.10, 95%CI: 0.030.17, P=0.009) also. However, the incidence of WHO 3/4 grade adverse reaction was increased significantly in the GEM+S1 group. Neutropenia, thrombocytopenia, and gastrointestinal reaction were increased by 18% (P=0.02), 18% (P=0.008) and 8% (P<0.000 01) respectively. ConclusionGEM combined with S1 can improve the chemotherapy effect compared with GEM alone. The adverse reactions also increase significantly, but the overall survival is benefit.

Key words: Pancreatic neoplasms, Drug therapy, Metaanalysis, Gemcitabine

蒋怡帆, 龚建平. 吉西他滨联合替吉奥与吉西他滨单药化疗治疗晚期胰腺癌比较的Meta分析[J]. 国际肿瘤学杂志, 2014, 41(3): 233-237.

JIANG Yi-Fan, GONG Jian-Ping. Gemcitabine plus S-1 versus gemcitabine alone in the treatment of advanced pancreatic cancer: a Meta-analysis[J]. Journal of International Oncology, 2014, 41(3): 233-237.

参考文献

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