Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
PLoS One. 2013 Apr 4;8(4):e60320. doi: 10.1371/journal.pone.0060320. Print 2013.
Gastric carcinoma (GC) is one of the highest cancer-mortality diseases with a high incidence rate in Asia. For surgically unfit but medically fit patients, palliative chemotherapy is the main treatment. The chemotherapy regimen of docetaxel, cisplatin and 5-fluorouracil (DCF) has been used to treat the advanced stage or metastatic GC. It is necessary to compare effectiveness and toxicities of DCF regimen with non-taxane-containing palliative chemotherapy for GC.
PubMed, EmBase, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure databases were searched to select relative randomized controlled trials (RCTs) comparing DCF to non-taxane-containing chemotherapy for patients with palliatively resected, unresectable, recurrent or metastatic GC. Primary outcome measures were 1-year and 2-year overall survival (OS) rates. Secondary outcome measures were median survival time (MST), median time to progression (TTP), response rate and toxicities.
Twelve RCTs were eligible and 1089 patients were analyzed totally (549 in DCF and 540 in control). DCF regimen increased partial response rate (38.8% vs 27.9%, p = 0.0003) and reduced progressive disease rate (18.9% vs 33.3%, p = 0.0005) compared to control regimen. Significant improvement of 2-year OS rate was found in DCF regimen (RR = 2.03, p = 0.006), but not of 1-year OS rate (RR = 1.22, p = 0.08). MST was significantly prolonged by DCF regimen (p = 0.039), but not median TTP (p = 0.054). Both 1-year OS rate and median TTP had a trend of prolongation by DCF regimen. Chemotherapy-related mortality was comparable (RR = 1.23, p = 0.49) in both regimens. In grade I-IV toxicities, DCF regimen showed a major raise of febrile neutropenia (RR = 2.33, p<0.0001) and minor raises of leucopenia (RR = 1.25, p<0.00001), neutropenia (RR = 1.19, p<0.00001), and diarrhea (RR = 1.59, p<0.00001), while in other toxicities there were no significant differences.
DCF regimen has better response than non-taxane containing regimen and could potentially improve the survival outcomes. The chemotherapy-related toxicity of DCF regimen is acceptable to some extent.
胃癌（GC）是癌症死亡率最高的疾病之一，在亚洲发病率较高。对于不适合手术但身体状况良好的患者，姑息性化疗是主要治疗方法。多西紫杉醇、顺铂和 5-氟尿嘧啶（DCF）的化疗方案已用于治疗晚期或转移性 GC。有必要比较 DCF 方案与非紫杉烷类姑息性化疗对 GC 的疗效和毒性。
检索 PubMed、EmBase、Cochrane 中央对照试验注册库和中国国家知识基础设施数据库，以选择比较 DCF 与非紫杉烷类化疗用于姑息性切除、不可切除、复发或转移性 GC 患者的相关随机对照试验（RCT）。主要结局指标为 1 年和 2 年总生存率（OS）。次要结局指标为中位生存时间（MST）、中位无进展生存期（TTP）、缓解率和毒性。
纳入 12 项 RCT，共分析了 1089 例患者（DCF 组 549 例，对照组 540 例）。与对照组相比，DCF 方案增加了部分缓解率（38.8% vs 27.9%，p=0.0003）和降低了进展性疾病率（18.9% vs 33.3%，p=0.0005）。与对照组相比，DCF 方案显著提高了 2 年 OS 率（RR=2.03，p=0.006），但未提高 1 年 OS 率（RR=1.22，p=0.08）。MST 显著延长（p=0.039），但中位 TTP 无显著延长（p=0.054）。与对照组相比，1 年 OS 率和中位 TTP 均有延长趋势。两组化疗相关死亡率相当（RR=1.23，p=0.49）。在 1-4 级毒性方面，DCF 方案引起发热性中性粒细胞减少症（RR=2.33，p<0.0001）明显增加，白细胞减少症（RR=1.25，p<0.00001）、中性粒细胞减少症（RR=1.19，p<0.00001）和腹泻（RR=1.59，p<0.00001）略有增加，而其他毒性无显著差异。
DCF 方案的疗效优于非紫杉烷类方案，可能改善生存结局。DCF 方案的化疗相关毒性在一定程度上是可以接受的。
