Soon Yu Yang, Leong Cheng Nang, Tey Jeremy Chee Seong, Tham Ivan Weng Keong, Lu Jiade Jay
Department of Radiation Oncology, National University Cancer Institute, Singapore, National University Health System, National University of Singapore, Singapore.
J Med Imaging Radiat Oncol. 2014 Aug;58(4):483-96. doi: 10.1111/1754-9485.12190. Epub 2014 Jul 3.
This study conducted a systematic review and meta-analysis (direct and indirect) of published randomised controlled trials (RCTs) to compare the effects of postoperative chemo-radiotherapy (ChRT) with chemotherapy (Ch) on overall and disease-free survival (DFS) for patients with resectable gastric cancer.
We searched MEDLINE and CENTRAL from the date of inception and annual meeting proceedings of American Society of Clinical Oncology and American Society for Radiation Oncology from 1999 to November 2012 for RCTs comparing postoperative ChRT with Ch, postoperative ChRT with surgery alone and postoperative Ch with surgery alone. The primary outcome was overall survival (OS); secondary outcomes included DFS and toxicity. Hazard ratios (HRs), confidence intervals (CIs) and P values (P) were estimated with fixed effects models using Revman 5.1.
We found six trials comparing postoperative ChRT with Ch (n = 1171). Meta-analysis of direct comparison trials showed that postoperative ChRT significantly improved both OS (HR 0.80, 95% CI 0.65-0.98, P = 0.03) and DFS (HR 0.76, 95% CI 0.63-0.91, P = 0.003) when compared with Ch. There were no significant differences in toxicity between the two groups.
This study suggests a survival benefit of postoperative ChRT over Ch in patients with resected gastric cancer.
本研究对已发表的随机对照试验（RCT）进行了系统评价和荟萃分析（直接和间接），以比较术后放化疗（ChRT）与单纯化疗（Ch）对可切除胃癌患者总生存期和无病生存期（DFS）的影响。
我们检索了MEDLINE和CENTRAL数据库自建库起至2012年11月的文献，以及美国临床肿瘤学会和美国放射肿瘤学会1999年至2012年年会论文集，以查找比较术后ChRT与Ch、术后ChRT与单纯手术以及术后Ch与单纯手术的RCT。主要结局为总生存期（OS）；次要结局包括DFS和毒性。使用Revman 5.1软件通过固定效应模型估计风险比（HR）、置信区间（CI）和P值（P）。
我们发现六项比较术后ChRT与Ch的试验（n = 1171）。直接比较试验的荟萃分析表明，与Ch相比，术后ChRT显著改善了OS（HR 0.80，95%CI 0.65 - 0.98，P = 0.03）和DFS（HR 0.76，95%CI 0.63 - 0.91，P = 0.003）。两组在毒性方面无显著差异。
本研究表明，对于已切除胃癌的患者，术后ChRT比Ch更有利于生存。
