Department of Oncology, Tianjin Medical University General Hospital, Tianjin, China.
Tianjin Fifth Central Hospital, Tianjin, China.
J Gastroenterol Hepatol. 2018 Jan;33(1):209-225. doi: 10.1111/jgh.13845.
5-Fluorouracil (5-Fu) is one of the most commonly prescribed antineoplastic agents against gastric and colorectal cancers. Continuous infusion would be the optimal way of its administration, however, may usually cause thrombosis, infection, and prolonged hospital stay. Oral fluoropyrimidines would be an attractive alternative, but their efficiency and toxicities for the treatment of gastric and colorectal cancer are still obscure as compared with infusion 5-Fu.
Literature retrieval, trials selection and assessment, data collection, and statistic analysis were performed according to the Cochrane Handbook. The outcome measures were tumor response rate, progression-free survival, overall survival, and adverse effects.
Twenty-nine randomized controlled trials, comprising totally 15 154 patients, were included. Meta-analysis showed similar overall outcome in terms of response rate (1.01; 95% confidence interval [CI], 0.92-1.12), progression-free survival (hazard ratio 1.00; 95%CI, 0.94-1.06), and overall survival (hazard ratio 0.96; 95%CI, 0.92-1.01) between oral fluoropyrimidine-based and intravenous 5-Fu-based regimens in gastric and colorectal cancer patients. The risk of grade 3/4 neutropenia, thrombocytopenia, and stomatitis was more prominent in intravenous 5-Fu-based regimens; while more frequent grade 3/4 hand-foot syndrome, diarrhea, and anorexia were detected in oral fluoropyrimidine-based regimens.
Oral-fluoropyrimidines showed equivalent response and similar survival outcomes, but different toxicity profiles, as compared with intravenous 5-Fu. Thus, it would be a more convenient and adjustable alternative in treatment of advanced gastric and colorectal cancer.
5-氟尿嘧啶（5-Fu）是治疗胃癌和结直肠癌最常用的抗肿瘤药物之一。持续输注是其最佳给药方式，但可能会导致血栓形成、感染和住院时间延长。口服氟嘧啶类药物是一种有吸引力的替代方法，但与 5-Fu 输注相比，其治疗胃癌和结直肠癌的疗效和毒性仍不清楚。
根据 Cochrane 手册进行文献检索、试验选择和评估、数据收集和统计分析。主要观察终点为肿瘤缓解率、无进展生存期、总生存期和不良反应。
共纳入 29 项随机对照试验，总计 15154 例患者。Meta 分析显示，口服氟嘧啶类药物与静脉注射 5-Fu 方案在胃癌和结直肠癌患者中的总体疗效（缓解率 1.01；95%置信区间 [CI]，0.92-1.12）、无进展生存期（风险比 1.00；95%CI，0.94-1.06）和总生存期（风险比 0.96；95%CI，0.92-1.01）方面相似。静脉注射 5-Fu 方案中 3/4 级中性粒细胞减少症、血小板减少症和口腔炎的风险较高；而口服氟嘧啶类药物方案中 3/4 级手足综合征、腹泻和厌食症的发生率较高。
口服氟嘧啶类药物与静脉注射 5-Fu 相比，在疗效和生存结局方面相似，但毒性谱不同。因此，它可能是治疗晚期胃癌和结直肠癌的一种更方便、更可调节的替代方案。
