胃癌术后放化疗与单纯化疗随机对照试验结果的荟萃分析

目的 采用偱证医学荟萃分析的方法比较胃癌术后放化疗与单纯化疗的RCT结果差异。 方法 检索中国期刊全文数据库、维普、中国生物医学文献数据库，Cochrane图书馆、PubMed和EMBASE，纳入胃癌术后放化疗及单纯化疗的RCT研究。汇总数据采用RevMan5.2及Stata12软件进行分析。两组间差异采用RR及95%CI描述。 结果 根据纳入和排除标准，最终纳入11个1 143例患者的RCT资料。荟萃分析结果显示胃癌术后放化疗比单纯化疗的1、2、3年OS率高（RR=1.20，95%CI=1.10～1.30，P=0.00；RR=1.34，95%CI=1.16～1.56，P=0.00；RR=2.62，95%CI=1.72～3.97，P=0.00）；3、5年PFS率也高（RR=1.10，95%CI=1.00～1.21，P=0.04；RR=1.27，95%CI=1.02～1.60，P=0.04)。胃肠道反应、肝功能损害、骨髓移植及手足综合征等3~4级发生率低且两组相似（P=0.03~0.78）。结论 胃癌术后放化疗可提高生存时间，且患者对药物的耐受性尚可。

Randomized controlled trials of postoperative chemoradiotherapy versus chemotherapy alone in patients with gastric cancer: a meta-analysis

Objective To compare the efficacy and safety between postoperative chemoradiotherapy and postoperative chemotherapy alone in patients with gastric cancer by a meta-analysis of randomized controlled trials (RCTs). Methods Chinese Scientific Journal Full-Text Database (January 1979-June 2013), VIP (January 1989-June 2013), Chinese Biomedical Literature Database (January 1978-June 2013), Cochrane Library (Issue 6, 2013), PubMed (January 1966-June 2013), and EMBASE (January 1974-June 2013) were searched to identify RCTs of postoperative chemoradiotherapy versus chemotherapy alone in patients with gastric cancer. The obtained data were analyzed using RevMan 5.2 and Stata 12. The difference between two groups was estimated by calculating the risk ratio (RR) with 95% confidence interval (CI). Results A total of 1 143 patients from 11 RCTs were included in the meta-analysis according to the inclusion and exclusion criteria. Our results showed that postoperative chemoradiotherapy significantly increased 1-, 2-, and 3-year overall survival rates (RR=1.20, 95% CI=1.10-1.30, P=0.00; RR=1.34, 95% CI=1.16-1.56, P=0.00; RR=2.62, 95% CI=1.72-3.97, P=0.00) and 3- and 5-year disease-free survival rates (RR=1.10, 95% CI=1.00-1.21, P=0.04; RR=1.27, 95% CI=1.02-1.60, P=0.04). The incidence of grade 3 or 4 gastrointestinal tract reactions, liver function impairment, bone marrow suppression, and hand-foot syndrome was low and showed little difference between two groups (P=0.03-0.78). Conclusions Postoperative chemoradiotherapy can prolong the survival of patients with gastric cancer, and the patients have good tolerance to chemotherapy drugs.