Wu Fang-Lan, Lu De-Cheng, Ying Yan-Ping, Huang Jin-Jiao, Zhou Ai-Min, Jiang Dun-Ke, Chen Mao-Wei, Yang Xi, Zhou Jia, Huang Hui-Qiao, Zeng Hong-Yan
From the Hospital Quality Management Office (F-LW); Department of Endocrinology (D-CL, A-MZ, XY, JZ, H-QH); Department of Thoracic and Cardiovascular Surgery (Y-PY); Outpatient Department (J-JH, H-YZ); Department of Gastroenterology (D-KJ); and Department of Infectious Disease, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China (M-WC).
Medicine (Baltimore). 2015 Apr;94(16):e652. doi: 10.1097/MD.0000000000000652.
The aim of this study was to compare the efficacy and safety of S-1-based therapy versus non-S-1-based therapy in advanced gastric cancer (AGC) patients.Eligible studies stratifying objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and adverse events (AEs) in AGC patients were identified from Embase, Pubmed, Cochrane Library, and China National Knowledge Infrastructure databases. The STATA package (version 11.0) was used to pool the data from the eligible studies.Fifteen studies with 2973 AGC cases, of which 1497 (50.4%) received S-1-based therapy and 1476 (49.6%) received non-S-1-based therapy, were identified in the meta-analysis. AGC patients who had received S-1-based therapy had a higher median OS, median PFS, and ORR than those who had received 5-fluorouracil (FU)-based therapy (OS: hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.80-0.98, P = 0.015; PFS: HR 0.88, 95% CI 0.80-0.98, P = 0.016; ORR: OR 1.25, 95% CI 1.08-1.45, P = 0.003, respectively). S-1-based therapy had similar efficacy to capecitabine-based therapy in terms of median OS (HR 1.14, 95% CI 0.91-1.41, P = 0.253), median PFS (HR 1.01, 95% CI 0.82-1.25, P = 0.927), and ORR (OR 0.84, 95% CI 0.63-1.12, P = 0.226). Subgroup analysis for grade 3 to 4 toxicity showed higher incidence of neutropenia (relative risk [RR] = 0.827, P = 0.006), nausea (RR = 0.808, P = 0.040), and lower diarrhea (RR = 1.716, P = 0.012) in 5-FU-based arm, and higher diarrhea (RR = 0.386, P = 0.007) in capecitabine-based arm.S-1-based chemotherapy is favorable to AGC patients with better clinical benefit than 5-FU-based chemotherapy and with equivalent antitumor compare with capecitabine-based therapy.
本研究旨在比较以S-1为基础的治疗与不以S-1为基础的治疗在晚期胃癌（AGC）患者中的疗效和安全性。从Embase、Pubmed、Cochrane图书馆和中国知网数据库中识别出符合条件的研究，这些研究对AGC患者的客观缓解率（ORR）、无进展生存期（PFS）、总生存期（OS）和不良事件（AE）进行了分层。使用STATA软件包（11.0版）汇总符合条件的研究数据。在荟萃分析中，共纳入15项研究，涉及2973例AGC病例，其中1497例（50.4%）接受了以S-1为基础的治疗，1476例（49.6%）接受了不以S-1为基础的治疗。接受以S-1为基础治疗的AGC患者的中位OS、中位PFS和ORR高于接受以5-氟尿嘧啶（FU）为基础治疗的患者（OS：风险比[HR]0.89，95%置信区间[CI]0.80-0.98，P = 0.015；PFS：HR 0.88，95%CI 0.80-0.98，P = 0.016；ORR：OR 1.25，95%CI 1.08-1.45，P = 0.003）。在中位OS（HR 1.14，95%CI 0.91-1.41，P = 0.253）、中位PFS（HR 1.01，95%CI 0.82-1.25，P = 0.927）和ORR（OR 0.84，95%CI 0.63-1.12，P = 0.226）方面，以S-1为基础的治疗与以卡培他滨为基础的治疗疗效相似。对3至4级毒性的亚组分析显示，以FU为基础的治疗组中性粒细胞减少症（相对风险[RR]=0.827，P = 0.006）、恶心（RR = 0.808，P = 0.040）的发生率较高，腹泻发生率较低（RR = 1.716，P = 0.012）；以卡培他滨为基础的治疗组腹泻发生率较高（RR = 0.386，P = 0.007）。与以FU为基础的化疗相比，以S-1为基础的化疗对AGC患者更有利，临床获益更好，且与以卡培他滨为基础的治疗相比，抗肿瘤效果相当。
