Petrelli F, Coinu A, Borgonovo K, Cabiddu M, Ghilardi M, Lonati V, Barni S
Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio, Italy.
Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio, Italy.
Clin Oncol (R Coll Radiol). 2014 Aug;26(8):488-96. doi: 10.1016/j.clon.2014.04.031. Epub 2014 May 21.
Advanced hepatocellular carcinoma (HCC), for which locoregional treatment is not an option, is a candidate for palliative systemic therapy, but an accepted chemotherapy regimen does not exist. We have conducted a systematic literature review and meta-analyses to quantify the benefits of oxaliplatin (OXA)-based chemotherapy in advanced HCC in patients not exposed to sorafenib. Studies that enrolled advanced HCC patients treated with first-line OXA-based chemotherapy were identified using PubMed, Web of Science, SCOPUS, The Cochrane Register of Controlled Trials and EMBASE. A systematic review was conducted to calculate the pooled response rate and 95% confidence interval. The pooled median progression-free survival (PFS) and overall survival, weighted on the number of patients of each selected trials, were also calculated. We tested for significant heterogeneity by Cochran's chi-squared test and I-square index. Thirteen studies were included in this review, with a total of 800 patients analysed. The pooled response rate was 16.8%. The median PFS and overall survival were 4.2 and 9.3 months, respectively, with a 1 year overall survival of 37%. The weighted median PFS/overall survival and response rate were 4.5/11 months and 20% in Western patients. Conversely, in Asiatic studies, the median PFS/overall survival and response rate were 2.43/6.47 months and 13.2%, respectively. OXA-based chemotherapy is effective in advanced HCC and represents a viable option in these patients. A head to head comparison with sorafenib or a second-line agent should be verified in prospective trials.
对于无法进行局部区域治疗的晚期肝细胞癌（HCC）患者，姑息性全身治疗是一种选择，但目前尚无公认的化疗方案。我们进行了一项系统的文献综述和荟萃分析，以量化在未接受索拉非尼治疗的晚期HCC患者中，基于奥沙利铂（OXA）的化疗的获益情况。通过PubMed、Web of Science、SCOPUS、Cochrane对照试验注册库和EMBASE等数据库，检索纳入一线使用基于OXA化疗方案治疗晚期HCC患者的研究。进行系统综述以计算汇总缓解率及95%置信区间。还计算了汇总的无进展生存期（PFS）中位数和总生存期，并根据各入选试验的患者数量进行加权。我们采用Cochran卡方检验和I²指数检验显著异质性。本综述纳入了13项研究，共分析了800例患者。汇总缓解率为16.8%。PFS中位数和总生存期分别为4.2个月和9.3个月，1年总生存率为37%。西方患者的加权PFS/总生存期中位数和缓解率分别为4.5/11个月和20%。相反，在亚洲研究中，PFS/总生存期中位数和缓解率分别为2.43/6.47个月和13.2%。基于OXA的化疗对晚期HCC有效，是这些患者的一个可行选择。应在前瞻性试验中验证与索拉非尼或二线药物的直接比较。
