摘要
目的通过Meta分析,探讨吉西他滨联合伊立替康治疗晚期胰腺癌的地位和价值。方法通过MEDLINE、EMBASE、ASCO论文集等数据库检索国内外已发表和未发表的相关文献。选择治疗组为吉西他滨联合伊立替康化疗,对照组为吉西他滨单药化疗的晚期胰腺癌随机对照试验(randomized controlled trial,RCT)。由2位评价者分别按上述检索策略收集资料,按纳入标准入选,主要对总生存率进行Meta分析,其次是客观缓解率和毒副反应。结果共纳入3个RCT。吉西他滨联合伊立替康化疗与吉西他滨单药化疗比较,前者半年生存率及一年生存率均无差别(P值分别为0.88,0.97),客观缓解率提高9%(P=0.0009);同时WHO3/4度骨髓毒性(除中性粒细胞减少症外)及非骨髓毒性可能增加:血小板减少症增加2%(P=0.46)、贫血增加1%(P=0.58),恶心/呕吐增加6%(P=0.34)、腹泻增加10%(P=0.10),但均未取得统计学意义。结论现有证据不推荐吉西他滨联合伊立替康一线治疗晚期胰腺癌。
Objective To compare gemcitabine-irinotecan （IRINOGEM） combination chemotherapy with gemcitabine （GEM） alone in patients with advanced pancreatic cancer （APCa） through meta-analysis. Methods MEDLINE, EMBASE and ASCO searches were supplied by information from trial registers. A quantitative meta-analysis using updated information basing on inclusion criterion from all available randomized controlled trials was carried out by two reviewers. The primary meta-analysis was based on overall survival （OS）.The second was objective remission rate （ORR） and toxicity. Results The Meta-analysis included 3 randomized controlled trials. There was a significant improvement for IRINOGEM combination group in ORR（RD=9%, P=0.0009）, but without significant improvement in 6 months survival rate（P=0.88） and 1 year survival rate（P=-0.97）. Meanwhile, WHO grade m/iv haematologic and non-haematologic toxicity may be increased in the IRINOGEM combination group except for neutropenia, with thrombocytopenia 2%, anemia 1%, nausea/vomit 6% and diarrhea 10% respectively. But all the toxicities did not reach statistical value. Conclusion According to present evidence, Gemcitabine combined with irinotecan combination should not be recommended as firstline therapy for APCa, because it has no significant survival benefit than GEM alone.
出处
《岭南现代临床外科》
2007年第2期101-103,113,共4页
Lingnan Modern Clinics in Surgery
