胃癌术后同步放化疗与单纯化疗疗效及毒副反应的Meta分析

目的通过评价胃癌术后同步放化疗与单纯化疗的疗效与毒副反应,确定胃癌术后更佳的治疗方案。方法 2名研究者分别检索Pubmed,EMBASE和Cochrane library及中国知网、万方、维普等文献检索库,时间为建库到2018-07。共纳入21篇随机对照试验,共计2 299例研究对象,主要结局指标为3年、5年总生存期(overall survival,OS),次要结局指标为3年、5年无疾病进展期(disease-free survival,DFS)和毒性反应。研究纳入P值、RR风险比、95%置信区间(95%CI)以及发表偏倚。结果术后同步放化疗较单纯化疗提高了3年及5年OS(RR=0.737,95%CI:0.664～0.819,P=0.000; RR=0.818,95%CI:0.718～0.932,P=0.003); 3年及5年DFS(RR=0.770,95%CI:0.686～0.864,P=0.000; RR=0.772,95%CI:0.620～0.962,P=0.021),但增加了Ⅲ度及以上的消化道系统及血液系统的毒副反应(RR=1.455,95%CI:1.134～1.868,P=0.003; RR=1.208,95%CI:1.036～1.410,P=0.016)。结论胃癌术后同步放化疗可延长OS及DFS,但增加了治疗相关毒副反应。

A Meta analysis of the efficacy and side effects of concurrent chemoradiotherapy and chemotherapy after gastric cancer surgery

Objective To evaluate the curative effect and toxic and side effects between postoperative chemo-radiotherapy(ChRT) and chemotherapy(Ch) to detemine the better treatment options.Methods Two investigators independently searched Pubmed,EMBASE,Cochrane library,CNKI,CQVIP and Wangfang Database(data span time from the time of establishing database to July 2018) for randomized controlled trials(RCTs) comparing postoperative ChRT with Ch.Twenty one RCTs comparing postoperative ChRT with Ch(n = 2 299) were included and2 299 patients were included.The primary outcomes were 3-and 5-year overall survival(OS),while the secondary outcomes were 3-and 5-year disease-free survival(DFS) and toxicity.P value(P),risk ratio(RR) and 95% confidence intervals(CIs) were calculated,and bias was analyzed.Results Postoperative ChRT improved 3-and 5-year OS and 3-and 5-DFS compared to postoperative Ch(RR = 0.737,95% CI: 0.664 ~ 0.819,P = 0.000;RR =0.818,95% CI: 0.718 ~ 0.932,P = 0.003;RR = 0.770,95% CI: 0.686 ~ 0.864,P = 0.000;RR = 0.772,95% CI:0.620 ~ 0.962,P = 0.021),but also increased the digestive system toxicity and hematological system toxicity(RR =1.455,95% CI: 1.134 ~ 1.868,P = 0.003;RR = 1.208,95% CI: 1.036 ~ 1.410,P = 0.016).Conclusion ChRT improves 3-and 5-year OS and 3-and 5-year DFS as compared to Ch alone,but also increases toxicities.