中国进展期胃癌含卡培他滨新辅助化疗初步研究Meta分析

目的：评价国内含卡培他滨的新辅助化疗方案对进展期胃癌手术切除率、根治性切除率及总有效率的影响。方法：计算机检索cNKI知识网络服务平台5．0（1994—2012—06）、万方数据库、维普中文生物医学期刊（1989—2012—07）、cHKD期刊全文数据库（1989—2012—01）、PubMed和Medline。手工检索所有纳入文献的相关参考文献，筛选有关国内卡培他滨用于进展期胃癌新辅助化疗的随机对照试验（randomizedcontrolledtrial，RCT），对符合入选标准的文献进行质量评价，采用STATA12．0软件进行Meta分析。结果：纳入国内统计根治性切除率和手术切除率的文献4篇，合计352例进展期胃癌患者，其中试验组172例，对照组180例；与单纯手术组或不舍卡培他滨的胃癌新辅助化疗组相比，含卡培他滨的胃癌新辅助化疗组可以提高进展期胃癌患者的根治性切除率（RR=1．624，95％CI：1．181～2．234）和手术切除率（RR=1．250，95％cI：1．071～l.460）。纳入国内统计总有效率的文献4篇，合计353例进展期胃癌患者，其中试验组175例，对照组178例；含卡培他滨的胃癌新辅助化疗组较不含卡培他滨的胃癌新辅助化疗组可以提高进展期胃癌患者的治疗总有效率，RR=1．258，95％CI：1．0041．517。结论：在进展期胃癌的术前化疗中，含卡培他滨的新辅助化疗方案可以提高进展期胃癌手术切除率、根治性切除率及总有效率，是一种值得推广的术前化疗方案。由于纳入研究样本量小且质量较低，上述结论尚需要高质量的随机双盲对照试验加以证实。

Domestic Meta-analysis of capecitabine combined with other drugs as neoadjuvant therapy in advanced gastric cancer

OBJECTIVE： To explore the efficacy of capecitabine combined with other drugs as a neoadjuvant chemo therapy in the treatment of advanced gastric cancer in China. METHODS：The CNKI （1994- 2012-06）, Wangfang Date, VMIS（1989-2012-07） ,CHKD（1989-2012-01）, PubMed and Medline were searched for literature. Manual retrieval of all relevant literature references were included to screen capecitabine combined with other drugs as a neoadjuvant chemo therapy in the treatment of advanced gastric cancer in randomized controlled trials（RCT）. The STATA12.0 software was used for Meta-analysis after extracting the useful data. RESULTS： 4 RCTs were included in the meta-analysis of curative resection rate and tumor resection rate. A total of 352 patients were included in the analysis,of which 172 patients were in the study group（capecitabine combined with other drugs as neoadjuvant chemotherapy plus surgery group） and 180 pa tients were in the control group（other neoadjuvant chemotherapy plus surgery group or immediate surgery group）. Compared with other neoadjuvant chemotherapy plus surgery group or immediate surgery regimen,capecitabine combined with other drugs plus surgery regimen had a significant benefit in increasing curative resection rate （RR = 1. 624,95% CI： 1. 181-2. 234） and tumor resection rate （RR= 1. 250,95 % CI： 1. 071- 1. 460）. The metwanalysis of the total effective rate included 4 RCTs,a total of 353 patients were included in the analysis,of which 175 patients were in the study group and 178 patients were in the control group, the meta-analysis showed that in comparison of capecitabine combined with other drugs plus surgery group and other neoadjuvant chemotherapy plus surgery group,there was statistically significantdifference in the total effective rate （RR= 1. 258,95 % CI. 1. 004-1.517）. CONCLUSIONS： According to the domestic evidence, the program capeeitabine combined with other drugs as neoadjuvant chemotherapy is safe and convenient. It had less side effects. It is a worthy preoperative chemotherapy. However, more high-quality, randomized and double-blind, con-trolled trials are required.