可切除或交界可切除胰腺癌新辅助放化疗+手术对比直接手术疗效及安全性Meta分析

目的 系统评价可切除或交界可切除胰腺癌新辅助放化疗+手术与直接手术治疗模式有效性及安全性差异。方法 以pancreatic neoplasm、pancreatic cancer、surgery、preoperative chemoradiotherapy、neoadjuvant chemoradiotherapy及胰腺癌、新辅助放化疗、手术为检索词,检索Pubmed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、万方、中国知网和维普数据库。检索时间为建库至 2020年2月。纳入新辅助放化疗+手术对比直接手术治疗可切除或交界可切除胰腺癌的随机对照试验(RCT)研究,由两名研究者独立筛选文献、提取数据和进行质量评价。总生存时间的评价采用HR及 95%CI表示,R0切除率、组间术后并发症发生率和治疗期间死亡率的评价采用RR及 95%CI表示,并且采用I²对纳入文献进行异质性检验。结果 最终纳入4项RCT研究,共 400例患者,其中新辅助放化疗+手术组 197例,直接手术组 203例。结果显示新辅助放化疗+手术组较直接手术组提高了总生存期(HR=0.76,95%CI为 0.60~0.97,P=0.03)以及R0切除率(RR=1.72,95%CI为 1.40~2.13,P<0.01),组间术后并发症发生率和治疗期间死亡率差异均无统计学意义(RR=1.02,95%CI为 0.73~1.43,P=0.90;RR=1.19,95%CI为 0.48~2.93,P=0.71)。结论 在可切除或交界可切除胰腺癌治疗中,新辅助放化疗+手术较直接手术可能会带来更多生存获益,且未增加术后不良反应发生率和治疗期间死亡率。新辅助放化疗+手术可作为可切除或交界可切除胰腺癌患者一种推荐治疗方式。     

食管癌放化疗后复发再程放疗的Meta分析

目的 Meta分析食管癌放化疗后复发再程放疗与其他疗法疗效和不良反应。方法 通过计算机检索PubMed、Embase、Cochrane Library、CNKI、万方等数据库,搜集有关食管癌放化疗后复发再程放疗与其他治疗方法比较的临床对照研究。检索时间为建库至 2020年4月。采用RevMan 5.1软件进行分析,组间差异采用RR及 95%CI描述。结果 根据纳入排除标准最终纳入11篇文献,包括 842例患者。Meta分析结果显示再程放疗组与手术组相比总生存率略低(RR=0.40,95%CI为 0.27~0.61,P<0.001),与单纯化疗组相比则得到了提高(RR=2.91,95%CI为 1.43~5.95,P=0.003)。再程放疗组与手术组治疗相关死亡率相近(RR=0.53,95%CI为 0.14~1.98,P=0.350),但手术组发生率较高(1.7%~11.4%∶1.9%~2.8%)。结论 再程放疗是放化疗后复发食管癌的有效治疗手段,可作为临床患者的选择方案。     

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。     

局限期SCLC超分割比常规分割放化疗疗效及安全性Meta分析

目的 系统评价放化疗治疗局限期SCLC时超分割与常规分割不同放疗模式有效性及安全性差异。方法 计算机检索Pubmed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、万方、中国知网和维普等数据库,查找超分割对比常规分割放化疗治疗局限期SCLC的临床对照研究文献。使用Revman 5.3统计软件对近期疗效、生存资料及不良反应进行Meta分析。结果 纳入8篇临床对照研究文献,共计1 361例患者。Meta分析结果显示,超分割组与常规分割组有着相似的客观缓解率(OR=1.31,95%CI为 0.64~2.69,P=0.46);两组间2、5年OS率相近(RR=1.10,95%CI为 0.98~1.24,P=0.12;RR=1.13,95%CI为 0.75~1.69,P=0.56);超分割组的≥2级放射性食管炎发生率较常规分割组高(RR=1.74,95%CI为 1.39~2.17,P<0.05),但两组间≥2级的放射性肺炎(RR=0.73,95%CI:0.24~2.24,P=0.58)、>3级血液学毒性(RR=1.18,95%CI为 0.99~1.39,P=0.06)发生率相近。结论 在局限期SCLC放化疗中两种放疗分割模式的近期疗效与生存获益相当,但超分割放疗的放射性食管炎发生率较高。超分割放疗并未带来较常规分割放疗更多的优越性。     

同步放化疗对伴有盆腹腔淋巴结转移的宫颈癌患者疗效分析

目的 研究同步放化疗是否提高根治术后伴有盆腹腔淋巴结转移宫颈癌患者的生存。方法 收集2008-2011年间188例行宫颈癌根治术且术后病理伴有盆腹腔淋巴结转移的患者的临床资料,分析同步放化疗的疗效。结果 全组46例患者出现复发转移,单纯放疗组后腹膜、髂总及盆腔非髂总转移者的复发转移分别为4、5、11例(57.1%、55.6%、28.2%);同步放化疗组相应的复发转移分别为5、5、16例(62.5%、25%、15.2%)。与单纯放疗相比,同步放化疗能够明显改善盆腔非髂总、髂总淋巴结转移者的5年生存率(非髂总88.6%∶76.9%,P=0.003;髂总80.0%∶44.4%,P=0.041),而不能改善腹主动脉旁淋巴结转移者的5年生存率(50.0%∶42.9%,P=0.973)。淋巴结转移的部位及同步放化疗是总生存率的影响因素(后腹膜比盆腔非髂总HR=4.259,95%CI=1.700~10.671,P=0.002;髂总比盆腔非髂总HR=2.985,95%CI=1.290~6.907,P=0.011;同步放化疗比放疗:HR=0.439,95%CI=0.218~0.885,P=0.021)。结论 同步放化疗能改善盆腔淋巴结转移患者的生存,但不能改善腹主动脉旁淋巴结转移患者的生存。     

食管癌术后辅助放化疗不良反应临床分析

目的 观察食管癌术后辅助性放化疗患者不良反应发生情况及其与临床因素的关系。方法 对2014年49例接受了术后辅助性放化疗的食管癌患者出现RG、RP及骨髓抑制情况进行Logistic法因素分析。结果 全组患者出现2级RG 19例(39%),2级RP 7例(14%),2级骨髓抑制8例(16%)。单因素分析结果显示与2级RG发生相关因素为胃长度大小(P=0.016);与2级RP发生相关因素为性别(P=0.026)和胃体积大小(P=0.047);与2级骨髓抑制发生相关因素为是否接受了≥2个周期化疗(P=0.000)。多因素分析结果显示胃长度大小为2级RG独立影响因素(P=0.038);胃体积大小为2级RP独立影响因素(P=0.013)。结论 术后胸腔胃状态影响着食管癌术后患者不良反应的发生情况,胃长度越长可能会增加2级RG的发生率,胃体积越大可能会增加2级RP的发生率。     

晚期胃癌二线化疗的预后因素分析

目的:探讨晚期胃癌患者二线化疗的预后因素,筛选二线化疗的最佳人群。方法:回顾性分析256例接受二线化疗的晚期胃癌患者,采用Kaplan-Meier法计算生存率,Log-rank检验比较各亚组生存率,采用Cox比例分析模型作临床病理特征对生存率影响的单因素和多因素分析。结果:二线化疗的客观有效率18.0%,中位至进展时间(TTP)3.0个月,中位生存期(OS)8.1个月,1年生存率24.4%。多因素分析发现,分化程度(RR=1.33;95%CI:1.02～1.74;P=0.04)、一线化疗的TTP(RR=2.12;95%CI:1.59～2.83;P=0.00)、二线化疗前PS评分(RR=5.42;95%CI:3.65～8.05;P=0.00)和血红蛋白(RR=3.56;95%CI:2.49～5.09;P=0.00)是晚期胃癌二线化疗的独立预后因素。根据患者含预后不良因素的个数,分为低危(0)、中危(1～2)和高危(3～4)3组,3组的中位生存期分别为10.2、6.4和3.3个月,1年生存率分别为39.2%和8.5%,0,P=0.00。结论:影响晚期胃癌二线化疗的独立预后因素包括分化程度、二线化疗前PS评分、血红蛋白和一线化疗的TTP,可作为筛选晚期胃癌二线化疗适宜人群的有效指标。     

可切除食管鳞癌新辅助同步放化疗加手术对比单纯手术的疗效及安全性Meta分析

目的 系统评价可切除食管鳞癌新辅助同步放化疗+手术与单纯手术模式的有效性及安全性差异。方法 计算机检索Embase、Pubmed、Web of Science、Cochrane library、万方、中国知网、中国生物医学文献数据库等,查找辅助同步放化疗联合手术对比单纯手术治疗可切除食管鳞癌的临床随机对照研究文献。使用Revman 5.3统计软件对生存资料、R0切除率、术后并发症发生率及治疗期间死亡率进行Meta分析。结果 最终纳入11个临床随机对照研究文献,共计1450例患者。结果显示新辅助同步放化疗+手术组有更高的2、5年总生存率(RR=1.14,95%CI为1.05~1.23,P=0.00)和2、5年无进展生存率(RR=1.56,95%CI为1.05~2.32,P=0.03);提高了R0切除率(RR=1.10,95%CI为1.05~1.14,P=0.00),术后心律失常发生率也较高(RR=2.45,95%CI为1.37~4.38,P=0.00)。两组术后并发症总发生率和治疗期间死亡率均相近(RR=1.12,95%CI为0.79~1.59,P=0.51和RR=1.78,95%CI为0.90~3.52,P=0.10)。结论 可切除食管鳞癌新辅助同步放化疗+手术较单纯手术带来更多生存获益,并未明显增加不良反应发生率,是治疗可切除食管鳞癌的一种可选方案。     

可切除食管鳞癌新辅助放化疗的Meta分析

目的:评价术前放化疗联合手术治疗(neoadjuvant chemoradiotherapy and surgery,CRT+S)与单纯手术治疗(surgery,S)对可切除食管鳞癌患者生存及手术的影响。方法:检索PubMed系统中所有CRT+S与S治疗可切除食管鳞癌的随机对照研究(randomized controlled trial,RCT),应用RevMan 5.2软件进行Meta分析。结果:共纳入10篇文献。CRT+S与S组比较:1)患者1年生存率差异无统计学意义,RR=1.03,95%CI为0.96～1.10,P=0.37。2)CRT+S组提高了3、5年生存率,3年RR=1.32,95%CI为1.17～1.50,P<0.001;5年RR=1.24,95%CI为1.03～1.49,P=0.02。3)相比于S组,CRT+S组的手术率较低,RR=0.84,95%CI为0.72～0.99,P=0.04;术后并发症的发生率较高,RR=1.25,95%CI为1.02～1.53,P=0.03;死亡率也较高,RR=2.34,95%CI为1.37～3.99,P=0.002;但提高了R0切除率,RR=1.18,95%CI为1.06～1.32,P=0.002。4)术后局部复发率差异无统计学意义,RR=0.82,95%CI为0.31～2.16,P=0.68;术后远处转移率差异无统计学意义,RR=0.86,95%CI为0.60～1.22,P=0.39。结论:CRT+S治疗明显提高了可切除食管鳞癌患者的长期生存率及R0切除率。     

可切除食管鳞癌新辅助同步放化疗加手术对比单纯手术的疗效及安全性Meta分析

目的 系统评价可切除食管鳞癌新辅助同步放化疗+手术与单纯手术模式的有效性及安全性差异。方法 计算机检索Embase、Pubmed、Web of Science、Cochrane library、万方、中国知网、中国生物医学文献数据库等,查找辅助同步放化疗联合手术对比单纯手术治疗可切除食管鳞癌的临床随机对照研究文献。使用Revman 5.3统计软件对生存资料、R0切除率、术后并发症发生率及治疗期间死亡率进行Meta分析。结果 最终纳入11个临床随机对照研究文献,共计1450例患者。结果显示新辅助同步放化疗+手术组有更高的2、5年总生存率(RR=1.14,95%CI为1.05~1.23,P=0.00)和2、5年无进展生存率(RR=1.56,95%CI为1.05~2.32,P=0.03);提高了R0切除率(RR=1.10,95%CI为1.05~1.14,P=0.00),术后心律失常发生率也较高(RR=2.45,95%CI为1.37~4.38,P=0.00)。两组术后并发症总发生率和治疗期间死亡率均相近(RR=1.12,95%CI为0.79~1.59,P=0.51和RR=1.78,95%CI为0.90~3.52,P=0.10)。结论 可切除食管鳞癌新辅助同步放化疗+手术较单纯手术带来更多生存获益,并未明显增加不良反应发生率,是治疗可切除食管鳞癌的一种可选方案。     

Benefit of radiotherapy on survival in resectable gastric carcinoma: a meta-analysis

We aimed to perform a meta-analysis to assess the impact of radiotherapy (RT) on both 3- and 5-year survival in patients with resectable gastric cancer. Relevant studies were identified by using PubMed, Embase and the Cochrane Controlled Trials Register through May 2013. We included randomized clinical trials (RCTs) that compared survival of surgery combined with RT (preoperative and/or postoperative) to surgery alone or surgery plus chemotherapy. Meta-analysis was performed using risk ratios (RRs). Both fixed- and random-effects models were used to calculate the summary risk estimates. Fourteen RCTs involving 2,853 participants were included in this meta-analysis. The addition of RT significantly increased the 3-year (RR 1.19; 95 % confidence interval (CI) 1.05–1.35) and 5-year survival (RR 1.25; 95 % CI 1.12–1.40). A significant advantage was also observed in subgroup analysis of preoperative RT for both 3-year (RR 1.56; 95 % CI 1.19–2.05) and 5-year overall survival (RR 1.40; 95 % CI 1.13–1.73). There was no evidence that preoperative RT increased postoperative mortality (RR 0.85; 95 % CI 0.42–1.72). Surgery combined with RT or chemoradiotherapy compared to surgery alone improved the 3-year (RR 1.18; 95 % CI 1.01–1.38) and 5-year survival rate (RR 1.38; 95 % CI 1.18–1.61). Although the quality of the studies was variable, the data were consistent, and no substantial publication bias was observed. In patients with resectable gastric carcinoma, adjuvant RT significantly increased the 3-year and 5-year survival. Preoperative RT is safe and definitely improves overall survival. Available evidence is insufficient to determine the benefit of postoperative RT after an extended lymphadenectomy and radical resection.     

Whole Brain Radiotherapy Plus Chemotherapy in the Treatment of Brain Metastases from Lung Cancer: A Metaanalysis of 19 Randomized Controlled Trails

Objective: To evaluate the efficacy and safety of whole brain radiotherapy (WBRT) plus chemotherapyversus WBRT alone for treating brain metastases (BM) from lung cancer by performing a meta-analysis basedon randomized controlled trials (RCTs). Methods: The PubMed, Embase, CENTRAL, ASCO, ESMO, CBM,CNKI, and VIP databases were searched for relevant RCTs performed between January 2000 and March 2012.After quality assessment and data extraction, the meta-analysis was performed using the RevMan 5.1 software,with funnel plot evaluation of publication bias. Results: 19 RCTs involving 1,343 patients were included. Themeta-analyses demonstrated that compared to WBRT alone, WBRT plus chemotherapy was more effective withregard to the objective response rate (OR = 2.30, 95% CI = 1.79 – 2.98; P < 0.001); however, the incidences ofgastrointestinal reactions (RR = 3.82, 95% CI = 2.33 - 6.28, P <0.001), bone marrow suppression (RR = 5.49,95% CI = 3.65 - 8.25, P < 0.001), thrombocytopenia (RR = 5.83, 95% CI = 0.39 - 86.59; P = 0.20), leukopenia(RR = 3.13, 95% CI = 1.77 – 5.51; P < 0.001), and neutropenia (RR = 2.75, 95% CI = 1.61 - 4.68; P < 0.001) inpatients treated with WBRT plus chemotherapy were higher than with WBRT alone. There was no obviouspublication bias detected. Conclusion: WBRT plus chemotherapy can obviously improve total efficacy rate,butalso increases the incidence of adverse reactions compared to WBRT alone. From the limitations of thisstudy, more large-scale, high-quality RCTs are suggested for further verification.     

Significant Efficacy of Additional Concurrent Chemotherapy with Radiotherapy for Postoperative Cervical Cancer with Risk Factors a Systematic Review and Meta-analysis

Background Whether concurrent chemotherapy treatment is superior to radiotherapy alone as an adjuvant regimen for postoperative cervical carcinoma with risk factors remains controversial. Materials and Methods A literature search strategy examined Pubmed, Embase, the Cochrane Library, the China National Knowledge Internet Web, the Chinese Biomedical Database and the Wanfang Database. Article reference lists and scienti c meeting abstracts were also screened. Controlled trials comparing concurrent chemoradiotherapy versus radiotherapy alone in postoperative cervical cancer were included. The methodological quality of non- randomized controlled trials was evaluated using the Newcastle-Ottawa Scale. Randomized controlled studies were evaluated with the Cochrane handbook. A meta-analysis was performed with RevMan 5.3. Results A total of 1,073 patients from 11 clinical trials were analysed, with 582 patients in the concurrent chemoradiotherapy group and 491 patients in the radiotherapy group. Hazard ratios (HR) of 0.47 (95% CI 0.31-0.72) and 0.50 (95% CI 0.35-0.72) were observed for overall survival and progression-free survival, indicating a bene t from the additional use of concurrent chemotherapy. Subgroup analyses demonstrated that cervical cancer with high risk factors signi cantly bene tted from concurrent chemotherapy when examining overall survival (HR 0.44, 95% CI 0.28-0.67) and progression-free survival (HR 0.48, 95% CI 0.33-0.70), but patients with intermediate risk factors showed no bene t from concurrent chemotherapy in overall survival (HR 1.72, 95% CI 0.28-10.41) and progression-free survival (HR 1.09, 95% CI 0.19-6.14). No signi cant differences were observed for grade 3-4 anaemia (risk ratio (RR) 3.87, 95% CI 0.69-21.84), grade 3-4 thrombocytopenia (RR 3.04, 95% CI 0.88- 10.58), grade 3-4 vomiting or nausea (RR 1.71, 95% CI 0.27-10.96), or grade 3-4 diarrhoea (RR 1.40, 95% CI 0.69-2.83). Signi cant differences were observed for grade 3-4 neutropenia in favour of the radiotherapy group (RR 7.23, 95% CI 3.94-13.26). Conclusions In conclusion, concurrent chemoradiotherapy improves survival in postoperative cervical cancer with high risk factors but not in those with intermediate risk factors.     

术后放疗与术后化疗辅助治疗子宫内膜癌的Meta 分析

目的：全面评价术后放疗与术后化疗辅助治疗子宫内膜癌的有效性和安全性，为临床合理选择提供决策依据。方法计算机检索 EMBase、PubMed、Cochrane Library、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、维普中文科技期刊全文数据库（VIP），检索截止时间为2015年8月31日。全面收集术后放疗与术后化疗辅助治疗子宫内膜癌的随机对照试验（RCT），两名评价者独立评价纳入文献的方法学质量并交叉核对提取资料，采用 RevMan 5．1软件进行统计分析。结果最终纳入3篇 RCT（1121例子宫内膜癌患者），Meta 分析结果显示，与术后化疗辅助治疗相比，术后放疗并不能提高子宫内膜癌5年生存率（RR ＝0．94，95％CI 为0．80～1．10，Z ＝0．77，P ＝0．440）、5年无疾病进展生存率（RR ＝0．98，95％CI 为0．90～1．07，Z ＝0．52，P ＝0．610）和降低复发率（RR ＝1．06，95％CI 为0．91～1．24，Z ＝0．75，P ＝0．450），但可降低3～4级血小板减少症（RR ＝0．13，95％CI 为0．07～0．27， Z ＝5．62，P ＜0．00001）和3～4级中性粒细胞减少症（RR ＝0．01，95％CI 为0．00～0．03，Z ＝8．27，P ＜0．00001），差异有统计学意义。对于Ⅲ～Ⅳ期子宫内膜癌患者而言，与术后放疗相比，术后化疗辅助治疗可以提高晚期子宫内膜癌的5年生存率（RR ＝0．79，95％CI 为0．68～0．91，Z ＝3．15，P ＝0．002）和5年无疾病进展生存率（RR ＝0．82，95％CI 为0．69～0．97，Z ＝2．31，P ＝0．020），且差异有统计学意义。结论当前证据表明，与术后放疗相比，术后化疗可能会提高晚期患者的生存率，其远期疗效尚待大样本高质量的 RCT 进一步证实。     

Prognostic model to predict survival following first-line chemotherapy in patients with metastatic gastric adenocarcinoma.

BACKGROUND: This study was to devise a prognostic model for metastatic gastric cancer patients undergoing first-line chemotherapy. PATIENTS AND METHODS: A retrospective analysis was carried out on 1455 gastric cancer patients, who received first-line chemotherapy from September 1994 to February 2005. RESULTS: At multivariate level, poor prognostic factors were no previous gastrectomy [P = 0.003; relative risk (RR), 1.191; 95% confidence interval (CI) 1.061-1.338], albumin < 3.6 g/dl (P = or <0.001; RR, 1.245; 95% CI 1.106-1.402), alkaline phosphatase > 85 U/l (P = or <0.001; RR, 1.224; 95% CI 1.092-1.371), Eastern Cooperative Oncology Group performance status of two or more (P = or <0.001; RR, 1.690; 95% CI 1.458-1.959), the presence of bone metastases (P = 0.001; RR, 1.460; 95% CI 1.616-1.836), and the presence of ascites (P = or < 0.001; RR, 1.452; 95% CI 1.295-1.628). Of 1434 patients, 489 patients (34.1%) were categorized as low-risk group (zero to one factors), 889 patients (62.0%) as intermediate-risk group (two to four factors), and 56 patients (3.9%) as high-risk group (five to six factors). Median survival durations for low, intermediate, and high-risk groups were 12.5 months, 7.0 months, and 2.7 months, respectively. CONCLUSIONS: This model should facilitate the individual patient risk stratification and thus, more appropriate therapies for each metastatic gastric cancer patient.     

The impact of radiotherapy on survival in resectable gastric carcinoma: a meta-analysis of literature data

BACKGROUND: The benefit of external radiotherapy for gastric carcinoma has been extensively studied, but data on survival are still equivocal. OBJECTIVE: To assess the effectiveness of surgery combined with preoperative radiotherapy or postoperative chemoradiotherapy in the reduction of all-cause mortality in patients with resectable gastric carcinoma. METHODS: Computerised bibliographic searches of MEDLINE and CANCERLIT (1970-2006) were supplemented with hand searches of reference lists. STUDY SELECTION: Studies were included if they were randomised controlled trials (RCTs) comparing mortality of surgery combined with preoperative radiotherapy or postoperative chemoradiotherapy to surgery alone, and if they included patients with histologically-proven gastric adenocarcinoma without metastases. Nine eligible RCTs, 4 of preoperative radiotherapy (832 patients) and 5 of postoperative chemoradiotherapy (869 patients), were identified and included in the meta-analysis. DATA EXTRACTION: Data on study populations, interventions, and outcomes were extracted from each RCT according to the intention to treat method by three independent observers and combined using the DerSimonian and Laird method. RESULTS: Surgery combined with preoperative radiotherapy compared to surgery alone significantly reduced the 3-year (OR 0.57; 95% CI 0.43-0.76: p=0.0001) and 5-year (OR 0.62; 95% CI 0.46-0.84; p=0.002) mortality rate. A significant reduction of the 5-year (OR 0.45; 95% CI 0.32-0.64; p<0.00001) mortality rate was observed when surgery followed by chemoradiotherapy was compared to surgery alone. CONCLUSIONS: In patients with resectable gastric carcinoma, adjuvant radiotherapy significantly reduces 3-year and 5-year all-cause mortality, but the magnitude of the benefit is relatively small. Available evidence is inadequate to determine whether postoperative chemoradiotherapy is superior to preoperative radiotherapy.     

MDR1 gene C3435T polymorphism is associated with clinical outcomes in gastric cancer patients treated with postoperative adjuvant chemotherapy

Objective: To evaluate the impact of the multi-drug resistance 1(MDR1) C3435T polymorphism on clinical outcomes in gastric cancer patients treated with postoperative adjuvant chemotherapy. Methods: From January 2005 to December 2008, 102 patients with surgically resected gastric cancers were enrolled into this study in the Affiliated Jiangsu Cancer Hospital of Nanjing Medical University. The polymorphism was tested using real time polymerase chain reaction (RT-PCR) cycling probes and the relationship with clinical outcomes after postoperative adjuvant chemotherapy was analyzed by SPSS 17.0. Results: The CT/TT genotype of C3435T was significantly associated with a shorter progression-free survival (PFS) and overall survival (OS) compared with the CC genotype [PFS: adjusted hazard ratio(HR)= 2.01, 95% confidence intervals(CI): 1.17-3.45, P = 0.012; OS: adjusted HR = 2.37, 95% CI: 1.31-4.28, P=0.004]. TNM stage was also associated with PFS (adjusted HR = 2.33, 95% CI: 1.34-4.05, P = 0.003) and OS (adjusted HR = 2.62, 95% CI: 1.44-4.76, P = 0.002) in gastric cancer patients treated with postoperative adjuvant chemotherapy. Conclusion: Our results suggest that the MDR1 gene C3435T polymorphism is associated with clinical outcomes in gastric cancer patients treated with postoperative adjuvant chemotherapy. This now needs to be confirmed by a randomized prospectively controlled study.