替吉奥为基础的化疗方案一线治疗晚期胃癌的Meta分析

目的:评价以替吉奥(S-1)为基础的化疗方案在晚期胃癌一线治疗中的疗效和不良反应。方法:通过中国知网、万方、EmBase及Pubmed数据库检索晚期胃癌一线接受以S-1为基础的化疗对比非S-1化疗方案的多中心随机对照研究(multicenter randomized clinical trial,mRCT),采用RevMan 5.2软件进行统计分析。评价客观有效率(objective response rate,ORR)、中位生存时间(median survival time,MST)、疾病进展时间(time to progress,TTP)和不良反应(adverse effects,AE)。结果:纳入5项mRCT,共2182例病例。Meta分析显示,S-1为基础的化疗方案与非S-1为基础的化疗方案相比,两组的ORR无显著性差异(33.67%vs 36.27%,RR=1.07,95%CI:0.91~1.26,P=0.42);S-1组较非S-1组TTP延长(5.1月vs 4.3月,P=0.006),但未显示出总生存优势(P>0.05)。S-1组的白细胞减少(Ⅰ-Ⅳ,P<0.0001;Ⅲ-Ⅳ,P<0.00001)、中性粒细胞减少(Ⅰ-Ⅳ,P<0.00001;Ⅲ-Ⅳ,P<0.00001)、血小板减少(Ⅰ-Ⅳ,P<0.0001;Ⅲ-Ⅳ,P=0.02)、食欲下降(Ⅲ-Ⅳ,P=0.002)、恶心(Ⅰ-Ⅳ,P=0.009;Ⅲ-Ⅳ,P=0.0002)、呕吐(Ⅰ-Ⅳ,P=0.01)和黏膜炎(Ⅰ-Ⅳ,P<0.00001;Ⅲ-Ⅳ,P<0.00001)均低于非S-1组,差异有统计学意义。结论:以S-1为基础的化疗方案与非S-1化疗方案一线治疗晚期胃癌在有效率、中位生存时间方面相当,但可延长TTP及降低不良反应。

Meta-analysis of S-1 and non-S-1 based chemotherapy regimens in advanced gastric cancer

Objective:To evaluate the safety and effect of S-1 based chemotherapy regimen in advanced gastric cancer by Meta-analysis.Methods:We searched the multicenter randomized control trials(mRCTs)comparing S-1 based chemotherapy to non-S-1 based chemotherapy regimens for advanced gastric cancer in electronic databases of CNKI,WANFANG,EmBase,Pubmed,up to December 1,2018.Primary outcome included objective response rate(ORR).Second outcome included median survival time(MST),time to progress(TTP)and adverse effects(AE).Results:Five mRCTs and 2182 patients were included in this Meta-analysis.We found equivalent ORR of the S-1 based chemotherapy regimen and non-S-1 based chemotherapy regimen as the first-line treatment for advanced gastric cancer(33.67%vs 36.27%,RR=1.07,95%CI:0.91~1.26,P=0.42).S-1 based chemotherapy regimen had longer TTP than non-S-1 based chemotherapy regimen(5.1 months vs 4.3 months,P=0.006),but no overall survival advantage(P>0.05).Non-S-1 based chemotherapy regimen had more toxicities than S-1 based regimen,such as leucopenia(Ⅰ-Ⅳ,P<0.0001.Ⅲ-Ⅳ,P<0.00001),neutopenia(Ⅰ-Ⅳ,P<0.00001.Ⅲ-Ⅳ,P<0.00001),thrombcytopenia(Ⅰ-Ⅳ,P<0.0001.Ⅲ-Ⅳ,P=0.02),anorexia(Ⅲ-Ⅳ,P=0.002),nausea(Ⅰ-Ⅳ,P=0.009.Ⅲ-Ⅳ,P=0.0002),vomiting(Ⅰ-Ⅳ,P=0.01),stomatitis(Ⅰ-Ⅳ,P<0.00001.Ⅲ-Ⅳ,P<0.00001).Conclusion:S-1 based chemotherapy regimen may be more attractive for gastric cancer patients for its non-inferior efficacy,better safety and more convenience compared with non-S-1 chemotherapy regimen.