Petrelli Fausto, Zaniboni Alberto, Coinu Andrea, Cabiddu Mary, Ghilardi Mara, Sgroi Giovanni, Barni Sandro
Medical Oncology Unit, Oncology Department, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy.
Medical Oncology Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
PLoS One. 2013 Dec 27;8(12):e83022. doi: 10.1371/journal.pone.0083022. eCollection 2013.
Cisplatin-based chemotherapy is frequently used to treat advanced gastric cancer (GC). Although it leads to increased overall survival (OS) when added to single agents or chemotherapy doublets, toxicity is also generally increased. The purpose of this meta-analysis study was to compare the efficacy of chemotherapy with and without cisplatin in patients with advanced GC.
Randomised trials that compared first-line cisplatin-based chemotherapy with regimens in which cisplatin was replaced by other agents were identified by electronic searches of PubMed, EMBASE, the Web of Science, and the Cochrane Central Register of Controlled Trials. Meta-analysis was performed using a fixed or random effects model. OS, reported as a hazard ratio (HR) and a 95% confidence interval (CI), was the primary outcome measure.
Fourteen trials (5 phase III and 9 phase II), including 2,981 patients, were identified. Overall, chemotherapy regimens without cisplatin significantly improved OS (HR, 0.79; 95% CI, 0.68-0.92; p = 0.003), progression-free survival (PFS) (HR, 0.77; 95% CI, 0.66-0.90; p = 0.001), and response rate (RR) (OR, 1.25; p = 0.004) when compared to cisplatin-containing regimens. A subgroup analysis according to histology, site of the primary tumour and extent of disease was not possible due to lack of data.
Compared with cisplatin-based doublets and triplets, combinations in which cisplatin was replaced by new drugs improved outcome and RRs in randomised trials for advanced GC and therefore should be strongly considered in the metastatic setting. A limitation of this meta-analysis is that we cannot identify a subgroup of patients (according to histology, site of primary tumour or burden of metastatic disease) which could derive greater benefit from cisplatin-free chemotherapy.
基于顺铂的化疗常用于治疗晚期胃癌（GC）。尽管将其添加到单药或双药化疗方案中可提高总生存期（OS），但毒性通常也会增加。本荟萃分析研究的目的是比较含顺铂与不含顺铂的化疗方案对晚期GC患者的疗效。
通过电子检索PubMed、EMBASE、科学网和Cochrane对照试验中央注册库，识别比较一线含顺铂化疗方案与用其他药物替代顺铂的方案的随机试验。使用固定或随机效应模型进行荟萃分析。以风险比（HR）和95%置信区间（CI）报告的OS是主要结局指标。
共纳入14项试验（5项III期和9项II期），包括2981例患者。总体而言，与含顺铂方案相比，不含顺铂的化疗方案显著改善了OS（HR，0.79；95%CI，0.68 - 0.92；p = 0.003）、无进展生存期（PFS）（HR，0.77；95%CI，0.66 - 0.90；p = 0.001）和缓解率（RR）（OR，1.25；p = 0.004）。由于缺乏数据，无法根据组织学、原发肿瘤部位和疾病范围进行亚组分析。
与基于顺铂的双药和三药方案相比，在晚期GC的随机试验中，用新药替代顺铂的联合方案改善了结局和RR，因此在转移性情况下应予以充分考虑。本荟萃分析的一个局限性是，我们无法确定（根据组织学、原发肿瘤部位或转移性疾病负担）哪些患者亚组可能从不含顺铂的化疗中获益更多。
