Liu T S, Wang Y, Chen S Y, Sun Y H
Department of Medical Oncology, Zhong Shan Hospital, Fu Dan University, Shanghai, China.
Eur J Surg Oncol. 2008 Nov;34(11):1208-16. doi: 10.1016/j.ejso.2008.02.002. Epub 2008 Mar 18.
To investigate whether and how much gastric cancer patients after curative resection could benefit from chemotherapy.
Meta-analysis was conducted with all the qualified clinical randomized trials which compared adjuvant chemotherapy with surgery alone. The database includes MEDLINE, EMBase and CBM disc, and the censor data were up to November 2007. Primary outcomes were relative risk (RR) on death and disease-free survival (DFS); secondary outcomes include RR of adverse reactions of the two arms. Sub-group analysis and sensitivity analysis were also performed. All the calculations and statistical tests were done with the RevMan 4.2.8 software.
Finally, 23 trials which included 4919 patients (2441 in the adjuvant chemotherapy arm, 2478 in the observation arm) achieved all the criteria. Among them, 19 studies reported the survival rate at the end of follow-up, 60.6% alive among 2286 patients in the adjuvant chemotherapy arm, 53.4% alive among 2313 patients in the observation arm, with the RR on death of 0.85 (95%CI: 0.80-0.90). Eight studies reported the DFS, and the observation arm had a shorter DFS (RR: 0.88, 95%CI: 0.77-0.99). Grade 3/4 of myelosuppression and GI toxicity occurred more frequently in the treatment arm. Nine studies reported the recurrence rate and suggested that the treatment arm had a lower recurrence rate (RR: 0.78, 95%CI: 0.71 approximately 0.86).
Statistically, adjuvant chemotherapy could improve the survival rate and disease-free survival rate in gastric cancer after curative resection and reduce the relapse rate. However, the clinical benefits of adjuvant chemotherapy still need to be improved. Additionally, post-operative chemotherapy could be tolerated.
探讨根治性切除术后的胃癌患者能否从化疗中获益以及获益程度。
对所有比较辅助化疗与单纯手术的合格临床随机试验进行荟萃分析。数据库包括MEDLINE、EMBase和中国生物医学文献数据库（CBM disc），检索截止日期为2007年11月。主要结局指标为死亡相对危险度（RR）和无病生存期（DFS）；次要结局指标包括两组不良反应的RR。同时进行亚组分析和敏感性分析。所有计算和统计检验均使用RevMan 4.2.8软件完成。
最终，23项试验（共纳入4919例患者，辅助化疗组2441例，观察组2478例）符合所有标准。其中，19项研究报告了随访结束时的生存率，辅助化疗组2286例患者中有60.6%存活，观察组2313例患者中有53.4%存活，死亡RR为0.85（95%CI：0.80 - 0.90）。8项研究报告了DFS，观察组的DFS较短（RR：0.88，95%CI：0.77 - 0.99）。3/4级骨髓抑制和胃肠道毒性在治疗组中更常见。9项研究报告了复发率，提示治疗组复发率较低（RR：0.78，95%CI：约0.71 - 0.86）。
从统计学角度看，辅助化疗可提高根治性切除术后胃癌患者的生存率和无病生存率，并降低复发率。然而，辅助化疗的临床获益仍有待提高。此外，术后化疗是可以耐受的。
