Jin Shui-Fang, Fan Zhao-Kun, Pan Lei, Jin Li-Ming
Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, China.
Hepatobiliary Pancreat Dis Int. 2017 Jun;16(3):236-244. doi: 10.1016/s1499-3872(17)60022-5.
Pancreatic cancer is one of the most aggressive malignancies and chemotherapy is an effective strategy for advanced pancreatic cancer. Gemcitabine (GEM) is one of first-line agents. However, GEM-based combination therapy has shown promising efficacy in patients with advanced pancreatic cancer. This meta-analysis aimed to compare the efficacy and safety of GEM-based combination therapy versus GEM alone in the treatment of advanced pancreatic cancer.
A comprehensive search of literature was performed using PubMed, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials. A quantitative meta-analysis was performed based on the inclusion criteria from all eligible randomized controlled trials. The outcome indicators included overall survival (OS), 6-month survival, 1-year survival, progression-free survival/time-to-progression (PFS/TTP), and toxicities.
A total of nine randomized controlled trials involving 1661 patients were included in this meta-analysis. There was significant improvement in the GEM-based combination therapy with regard to the OS (HR=0.85, 95% CI: 0.76-0.95, P=0.003), PFS (HR=0.76, 95% CI: 0.65-0.90, P=0.002), 6-month survival (RR=1.09, 95% CI: 1.01-1.17, P=0.03), and the overall toxicity (RR=1.68, 95% CI: 1.52-1.86, P<0.01). However, there was no significant difference in the 1-year survival.
GEM-based combination chemotherapy might improve the OS, 6-month survival, and PFS in advanced pancreatic cancer. However, combined therapy also added toxicity.
胰腺癌是侵袭性最强的恶性肿瘤之一，化疗是晚期胰腺癌的有效治疗策略。吉西他滨（GEM）是一线治疗药物之一。然而，基于吉西他滨的联合治疗在晚期胰腺癌患者中已显示出有前景的疗效。本荟萃分析旨在比较基于吉西他滨的联合治疗与单纯吉西他滨治疗晚期胰腺癌的疗效和安全性。
使用PubMed、EMBASE、科学网和Cochrane对照试验中心注册库对文献进行全面检索。根据所有符合条件的随机对照试验的纳入标准进行定量荟萃分析。结局指标包括总生存期（OS）、6个月生存率、1年生存率、无进展生存期/疾病进展时间（PFS/TTP）和毒性。
本荟萃分析共纳入9项涉及1661例患者的随机对照试验。基于吉西他滨的联合治疗在OS（HR = 0.85，95%CI：0.76 - 0.95，P = 0.003）、PFS（HR = 0.76，95%CI：0.65 - 0.90，P = 0.002）、6个月生存率（RR = 1.09，95%CI：1.01 - 1.17，P = 0.03）和总体毒性（RR = 1.68，95%CI：1.52 - 1.86，P < 0.01）方面有显著改善。然而，1年生存率无显著差异。
基于吉西他滨的联合化疗可能改善晚期胰腺癌的OS、6个月生存率和PFS。然而，联合治疗也增加了毒性。
