胃癌术后辅助放化疗与辅助化疗比较的荟萃分析

目的 采用偱证医学荟萃分析的方法比较胃癌术后辅助放化疗与辅助化疗间的疗效差异。方法 计算机检索PubMed、EMbase、Cochrane图书馆、万方、维普、CNKI及中国生物医学等数据库,搜集有关胃癌术后辅助放化疗和辅助化疗比较的临床对照研究资料,汇总数据采用RevMan 5.2.5和Stata 12.0软件进行分析。两组间差异采用优势比(OR)及95%可信区间(95% CI)描述。结果 根据纳入和排除标准,最终纳入12个包括1674例患者的临床对照研究资料。荟萃分析结果显示,与胃癌术后辅助化疗相比,辅助放化疗的3、5年生存率更高(OR=2.96,95% CI= 1.75~5.03,P=0.000;OR=1.45,95% CI=1.06~1.99,P=0.020),辅助放化疗的局部复发率更低(OR=0.50,95% CI=0.34~0.72,P=0.000),但远处转移率两组相似(OR=0.79,95% CI=0.58~1.07,P=0.130)。结论 现有研究结果的荟萃分析显示,与胃癌术后辅助化疗相比,胃癌术后辅助放化疗是一种较为安全和有效的治疗方法。     

Recent advances in chemotherapy for advanced gastric cancer

Although medical treatment has been shown to improve quality of life and prolong survival, no significant progress has been made in the treatment of advanced gastric cancer (AGC) within the last two decades. Thus, the choice of optimum standard first-line chemotherapy regimen for AGC remains debatable, and most responses to chemotherapy are partial and of short duration, with a median survival of approximately 7-11 mo and survival at 2 years rarely more than 10%. Recently, remarkable progress in tumor biology has led to the development of new agents that target critical aspects of oncogenic pathways. For AGC, several molecular targeting agents are now under evaluation in international randomized studies, and trastuzumab, an anti-HER2 monoclonal antibody, has shown antitumor activity against HER-2 positive AGC. However, this benefit is limited to only about 20% of patients with AGC (patients with HER-2 positive AGC). Therefore, there remains a critical need for both the development of more effective agents and the identification of predictive and prognostic molecular markers to select those patients who will benefit most from specific chemotherapeutic regimens and targeted therapies.     

Recent advances is surgical adjuvant chemotherapy for colorectal cancer

To evaluate the significance of surgical adjuvant chemotherapy, randomized controlled trials (RCTs) of adjuvant chemotherapy after curative resection for colorectal cancer were reviewed. Several multi-drug systemic chemotherapies (MOF, MMC/FT, 5-FU, UFT p.o.) were useful as adjuvant treatment to improve survival or disease-free survival of patients with colorectal cancer. Moreover, a worldwide meta-analysis suggested that continuous intraportal 5-FU infusion improves survival. Combination chemotherapy trials utilizing 5-FU and levamisol (LEV) demonstrated a survival advantage in patients with high risk colon cancer. Recently, many RCTs have substantiated the benefits of treatment with 5-FU/Leucovorin (LV) and this treatment is widely used as adjuvant treatment for the patients with Dukes C resected colon cancer in Europe and the U.S.A. Now, with the increasing use of oral chemotherapy drugs, new trials comparing oral UFT/LV with intravenous 5-FU/LV are being implemented to investigate these drugs in terms of QOL, toxicity and cost. Furthermore, the new drug irinotecan (CPT-11) is now under investigation to see if it brings added efficacy to 5-FU/LV. In Japan, two major groups (N-SAS-CC and TAC-CR) are comparing surgery alone and UFT alone in patients with Dukes C colon and rectal cancer. From these results, surgical adjuvant chemotherapy seems to be effective in the treatment of patients with high risk colon cancer and those with rectal cancer.     

不能切除进展期胃癌新辅助化疗的评价：临床,组织学效果

目的　为探讨进展期胃癌新辅助化疗 ( NACT)效果。方法对 11例不能切除高度进展期胃癌采用新的辅助化学疗法 ,即术前化疗 ,应用 5-氟尿嘧啶顺铂 ( 5- Fu/ CDDP)或卡铂 ( CBDCA)方案 ,5-Fu750 mg/ m2、CDDP60 mg/ m2或 CBDCA4 0 0 mg/ m2动脉、腹腔给药 1～ 2个疗程。结果　临床效果 :完全缓解 ( CR) 0例 ,部分缓解 ( PR) 8例 ,无变化 ( NC) 3例 ,进展 ( PD) 0例 ,有效率 72 .7% ( 8/ 11) ,腹水消失有效率 85.7% ( 6/ 7)。PR8例中 ,手术切除 7例 ,占 63.6% ( 7/ 11)。组织学效果 :轻度有效 ( a) 3例 ,中度有效 ( b) 3例 ,显著有效 ( ) 1例。副作用主要是骨髓抑制 ,2～ 3周可恢复。 7例术后 5- FuCDDP或 CBDCA辅助化疗 1～ 2个疗程 ,除 1例术后 3个月死于肠梗阻外 ,其余 6例生存 ,一般状态( PS) 0～ 2级。结论新辅助化疗作为高度进展期胃癌综合治疗一部分 ,对改善病期 ,使不可能手术患者变为可能手术 ,提高手术切除率能发挥重要作用。     

The latest advances in chemotherapy for gastrointestinal cancers

During the past decade, there has been much progress in various nonsurgical treatments for gastrointestinal malignancies. Endoscopic mucosal resection (EMR) has been widely used as a standard treatment for early gastrointestinal cancers in Japan. For esophageal cancer, definitive chemoradiotherapy with or without EMR has shown the possibility of results comparable with those of surgery in stage I-III disease and is being evaluated in Japan Clinical Oncology Group (JCOG) studies. Definitive chemoradiotherapy with curative intent for locally advanced (T4/M1a) diseases has had a 5-year survival of 17%. In gastric cancers, although no standard regimen has been established yet, recently developed new agents have achieved higher response rates than before. To establish a new standard, various randomized trials including these new agents are now underway. There has been obvious progress in chemotherapy for colorectal cancer. Newly developed agents such as irinotecan and oxaliplatin have provided significant survival prolongation for metastatic colorectal cancer in randomized trials. In other gastrointestinal malignancies, nonsurgical treatments, including eradication of Helicobacter pylori, chemotherapy, and radiotherapy for primary gastric lymphoma are being evaluated in prospective studies. A new molecular targeting agent, imatinib, has provided significant impact in the treatment of gastrointestinal stromal tumor. To provide these advantages to patients, many more gastrointestinal oncologists are urgently needed in Japan.Presentation made at the ASCO-JSCO Joint Symposium held at Tokyo, Japan, on October 18, 2002.     

直肠癌同步放化疗与辅助化疗

辅助及新辅助治疗是直肠癌最重要的综合治疗手段,新辅助同步放化疗和术后辅助化疗在直肠癌治疗中起着至关重要的作用。一些新的化疗和靶向药物的出现可以进一步改善直肠癌的治疗效果。     

Resected gastric cancer with D2 dissection: advances in adjuvant chemoradiotherapy and radiotherapy techniques

Surgery is the main treatment option for locally advanced gastric cancer. D2 dissection has been recommended worldwide as standard lymphadenectomy for resectable gastric cancer. Furthermore, the role of peri- or postoperative chemotherapy for D2-dissected gastric cancer has been established in both Western and European countries. It has been disputed whether adding radiotherapy to chemotherapy could further benefit those patients. Until recently, studies from Korea and China may have made it clear. In North America, however, the INT-0116 trial does not rule out that chemoradiotherapy is effective in patients with D2 dissection, but the ongoing CRITICS trial will, hopefully, clarify this. In addition, literature published in the past decade supports the theory that improved radiotherapy techniques are likely to accurately deliver radiation dose and significantly reduce radiation toxicity. Finally, the status of E2F-1 and HER-2 may be associated with efficacy of radiotherapy based on retrospective studies.     

胃癌辅助化疗的研究进展

胃癌一直是肿瘤死亡的主要原因,手术根治性切除是治愈的唯一手段。胃癌辅助化疗是在根治性手术后减少局部和远处复发的方法。许多Ⅲ期临床研究试图证实辅助治疗的疗效,但至今仍没有确立标准的治疗方案。本文就辅助治疗在胃癌中的进展作一总结。     

胃癌术后辅助化疗研究进展

辅助化疗是在根治性手术后减少局部和远处复发的方法。其中，术后辅助化疗包括全身化疗、腹腔灌注化疗。新一代的化疗药物卡培他滨、奥沙利铂、紫杉醇、依立替康、S—1等显示出很好的治疗前景，化疗敏感试验的开展可能有助于个体化化疗方案的制定。腹腔灌注化疗有助于降低腹腔局部复发。     

Recent developments in adjuvant chemotherapy for colorectal cancer

Recent developments in the use of systemic chemotherapy and intraportal dchemotherapy in the treatment for colorectal cancer suggests that a reduction in mortality is achievable. This paper provides an overview of the management of colorectal cancer and the rationale behind adjuvant chemotherapy. A review of the current research literature published from both America and Europe will follow. Finally, the limitations and implications of the reviewed data will be discussed.     

The addition of chemoradiation to adjuvant chemotherapy is associated with improved survival in lymph node-positive gastric cancer

BackgroundIn the ARTIST trial, chemoradiation did not improve disease-free survival (DFS) in gastric cancer patients treated with curative-intent surgery and adjuvant chemotherapy. Subgroup analysis suggested chemoradiation improved DFS in patients with lymph node (LN) metastases, but the role of adjuvant chemoradiation remains uncertain. This study sought to determine the role of adjuvant chemoradiation using population-based methods.MethodsSurveillance, Epidemiology and End Results-Medicare linked data from 2004 to 2013 was used to identify patients aged 66 and older with LN-positive gastric adenocarcinoma. Multivariable logistic regression evaluated factors associated with receipt of chemoradiation. The Kaplan-Meier method and Cox proportional hazards modeling were used to evaluate overall survival (OS).ResultsA total of 2409 patients with LN-positive gastric adenocarcinoma who underwent upfront surgical resection were identified; 309 (13%) received adjuvant chemotherapy and 407 (17%) received adjuvant chemotherapy and chemoradiation. Among all patients, median OS was 15 months. Median OS was 20 months for patients who received chemotherapy alone and 27 months for patients who received chemotherapy and chemoradiation (p < 0.05). Recent diagnosis, older age, tumor stage T3 or T4, and Charleston Comorbidity Index were associated with an increased hazard ratio for death (p < 0.05). Receipt of chemoradiation was associated with a decreased hazard ratio for death (p < 0.05).ConclusionsIn patients with LN-positive gastric adenocarcinoma, the addition of chemoradiation to adjuvant chemotherapy after upfront surgical resection was associated with improved survival irrespective of the extent of lymphadenectomy. These data suggest chemoradiation should be considered in patients with LN-positive gastric adenocarcinoma.     

结直肠癌辅助化疗的新观念和新进展

辅助化疗是结直肠癌综合治疗中的重要组成部分,也是防治远处转移的主要手段.近年来,结直肠癌辅助化疗涌现了许多新观念,取得了许多新进展.本文对此进行全面阐述,以指导临床上合理应用辅助化疗,提高结直肠癌的疗效,延长患者的生存期,改善生活质量.     

西妥昔单抗联合化疗在消化系统肿瘤中的临床应用

目的 评价西妥昔单抗联合化疗治疗消化系统肿瘤的疗效和安全性.方法 回顾性分析行西妥昔单抗联合化疗的35例结直肠癌(CRC)、11例进展期胃癌(AGC)和3例其他消化系统肿瘤患者的临床资料,观察其疗效和不良反应.结果 全组可评价疗效者共37例.CRC中,可评价疗效者29例,其有效率(RR)为24.1%(7/29),疾病控制率(DC)为75.9%(22/29);其中一线治疗的RR为36.4%,DC 为90.9%;二线治疗的RR为20.0%,DC 为70.0%;三线及以上治疗的RR 为12.5%,DC 为62.5%.AGC中,可评价疗效者6例,其中一线治疗的2例患者均获部分缓解,二线治疗完全缓解和病情稳定者各1例,三线及以上治疗病情进展者2例.不良反应以皮疹、恶心、呕吐以及粒细胞下降多见.全组皮疹的发生率为79.6%,其中重度皮疹占8.2%.CRC的疗效与皮疹分级相关.结论 西妥昔单抗联合化疗在CRC中安全有效,一线治疗疗效最佳,其疗效与皮疹分级相关;在AGC治疗中也有应用前景.     

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。     

乳腺癌辅助化疗的新进展

辅助化疗、内分泌治疗对乳腺癌远期无瘤生存率和总生存率有明显提高。目前乳腺癌辅助化疗应用最多的仍是蒽环类及紫杉类药物。已证明,单用紫杉类比单用蒽环类药物疗效更好。由于具有不同的抗癌机制,紫杉类与蒽环类联用可取得更好疗效。对于乳腺癌的辅助治疗,如何选择给药方式、给药密度,以达到最佳的远期疗效是目前关注的焦点之一。此外,利用生物标志物对临床早期乳腺癌预后的指导作用,在化疗及内分泌治疗中进行合理取舍,提高疗效、降低复发及治疗风险,也是目前的研究方向。     

乳腺癌辅助化疗的新进展

辅助化疗、内分泌治疗对乳腺癌远期无瘤生存率和总生存率有明显提高。目前乳腺癌辅助化疗应用最多的仍是蒽环类及紫杉类药物。已证明，单用紫杉类比单用蒽环类药物疗效更好。由于具有不同的抗癌机制，紫杉类与蒽环类联用可取得更好疗效。对于乳腺癌的辅助治疗，如何选择给药方式、给药密度，以达到最佳的远期疗效是目前关注的焦点之一。此外，利用生物标志物对临床早期乳腺癌预后的指导作用，在化疗及内分泌治疗中进行合理取舍，提高疗效、降低复发及治疗风险，也是目前的研究方向。     

Current status of adjuvant chemotherapy for gastric cancer

Although radical gastrectomy is a standard treatment for advanced gastric cancer, recurrence remains high. After several large-scale controlled studies have shown the beneficial effects of adjuvant chemotherapy, that treatment emerged as a standard option for advanced gastric cancer after gastrectomy. However, various guidelines from different countries have suggested different adjuvant chemotherapies. Understanding the differences between guidelines is very important for investigating further therapeutic strategies. Fortunately, because there are many ongoing studies about new regimens for adjuvant treatment, it is expected that patients with gastric cancer after surgery will have better outcome.