Chan Wing-Lok, Yuen Kwok-Keung, Siu Steven Wai-Kwan, Lam Ka-On, Kwong Dora Lai-Wan
Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, Hong Kong.
Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, Hong Kong.
Crit Rev Oncol Hematol. 2017 Aug;116:68-81. doi: 10.1016/j.critrevonc.2017.05.002. Epub 2017 May 24.
This review evaluated the efficacy, toxicities and quality of life of third-line systemic treatment (TLT) versus best supportive care (BSC) in metastatic gastric cancer patients after failing two lines of systemic treatment. Six studies were included, involving 890 participants (TLT: 587, BSC: 303, Asian: 679, 76.3%), median 53-61 years old, ECOG 0-1 with no major co-morbidities. Compared with BSC, TLT improved overall survival (HR 0.63; 95% CI 0.46-0.87, corresponding to an improvement in medial OS from 3.20 to 4.80 months), progression-free survival (HR 0.29; 95% CI 0.18-0.45), objective response rate (RR 5.28; 95% CI 1.00-27.83) and disease control rate (RR 4.51; 95% CI 2.64-7.71). The efficacy results favoring TLT should be interpreted with caution for the substantial heterogeneities, wide confidence intervals and selection bias. More toxicities occurred in the TLT arms. This review highlighted the paucity of QOL data. Future studies should focus more on QOL-related outcomes. PROSPERO registration: 2015 CRD42015017873.
本综述评估了转移性胃癌患者在接受两线全身治疗失败后，三线全身治疗（TLT）与最佳支持治疗（BSC）的疗效、毒性及生活质量。纳入六项研究，涉及890名参与者（TLT组：587例，BSC组：303例，亚洲人：679例，占76.3%），年龄中位数为53 - 61岁，东部肿瘤协作组（ECOG）体能状态评分为0 - 1，无严重合并症。与BSC相比，TLT改善了总生存期（风险比[HR] 0.63；95%置信区间[CI] 0.46 - 0.87，相当于中位总生存期从3.20个月提高到4.80个月）、无进展生存期（HR 0.29；95% CI 0.18 - 0.45）、客观缓解率（RR 5.28；95% CI 1.00 - 27.83）和疾病控制率（RR 4.51；95% CI 2.64 - 7.71）。由于存在显著异质性、宽置信区间和选择偏倚，对支持TLT的疗效结果应谨慎解读。TLT组出现了更多毒性反应。本综述强调了生活质量数据的匮乏。未来研究应更多地关注与生活质量相关的结果。国际前瞻性系统评价注册库（PROSPERO）注册号：2015 CRD42015017873。
