摘要
目的评价术前动脉灌注化疗与全身静脉化疗或单独手术治疗局部晚期胃癌的有效性和安全性。方法计算机检索PubMed(2000年1月—2011年5月)、EMBASE(2000年1月—2011年5月),Cochrane Library(2011年第4期),中国生物医学文献数据库(CBM,2000年1月—2011年5月)、中国期刊全文数据库(CJFD,2000年1月～2011年5月)和中文科技期刊全文数据库(CSJD,2000年1月—2011年5月),同时从参考文献中追溯查找。按照纳入标准,全面搜集有关术前动脉灌注化疗(IAIC+S)与全身静脉化疗(IVC+S)或单独手术(S)治疗局部晚期胃癌方面的临床对照试验,无论是否采用随机对照研究。按照Cochrane系统评价方法,由两位研究者独立提取资料和进行质量评价,并用Rev-Man5.1软件进行统计分析。结果共纳入7个研究,792例患者。Meta分析结果显示,IAIC+S组与IVC+S组相比,根治性切除率差异有统计学意义,RR(95%CI)为1.70(1.41～2.05),姑息性切除率差异无统计学意义,RR(95%CI)为0.37(0.04～3.13)。在治疗应答率中,病理学应答率、临床应答率RR(95%CI)分别为1.33(0.96～1.84)和1.32(0.50～3.44)。化疗不良反应中,除胃肠反应RR(95%CI)为0.52(0.28～0.94),骨髓抑制、肝功能损害和其他不良反应方面,两组间差异均无统计学意义,RR(95%CI)分别为0.64(0.38～1.07)、0.88(0.29～2.64)、0.93(0.53～1.61)。术后并发症方面,吻合口瘘、腹腔感染和切口感染,两组间差异均无统计学意义,RR(95%CI)分别为2.46(0.49～12.34)、0.53(0.05～5.57)、2.10(0.20～22.26)。IAIC+S组与S组相比,根治性切除和姑息性切除率方面两组间差异均存在统计学意义,RR(95%CI)分别为1.30(1.16～1.45)和0.58(0.42～0.79)。1、2、3和5年生存率间差异均有统计学意义,RR(95%CI)分别为1.11(1.03～1.20)、1.36(1.09～1.69)、1.70(1.35～2.14)和1.85(1.30～2.65)。术后并发症方面,无论吻合口瘘、腹腔感染和切口感染方面两组间差异均无统计学意义,RR(95%CI)分别为0.
Objective To assess the clinical efficacy and safety of preoperative intra-arterail infusion chemothrapy（IAIC＋S）＋surgery（S）versus Preoperative intravenous chemotherapy＋S（IVC＋S）or S alone for locally advanced gastric carcinoma.Methods PubMed（January,2000to May,2011）,EM BASE（January,2000to May,2011）,Cochrane Library（Issue 4,2011）,Chinese Biomedical Literature Database（January,2000to May,2011）,China Journal Full text Database（January,2000to December,2007）,and Chinese Scientific Journals Full text Database（January,2000to December,2007）were searched for relevant original published in any date.We also track back to the references to collect trails.Inclusion criteria were as follows：clinical controlled trails regardless of randomization were reported in English or Chinese.Two reviewers extracted data and assessed the quality of included trials independently.The RevMan 5.1software was used for statistical analysis.Results Seven studies involving 792patients were included.Metaanalysis showed that,between（IAIC＋S）and（IVC＋S）,there was significant difference in radical resection rate,and the pooled RR（95%CI）was 1.70（1.41～2.05）.But in response rate,complications of postoperation and chemotherapy side effects,they all had no statistical difference.Between（IAIC＋S）and S alone,RRs of radical and palliative resection rates（95%CI）were 1.30（1.16～1.45）and 0.58（0.42～0.79）respectively.All 1-year,3-year,4-year,5-year and overall survival had statistical signicance,with 1.11（1.03～1.20）,1.36（1.09～1.69）,1.70（1.35～2.14）and 1.85（1.30～2.65）,respectively.In postoperative complications,RRs（95%CI）of anastomotic leakage,abdominal infection and wound infection were 0.78（0.27～2.28）,0.65（0.16～2.65）and 1.15（0.43～3.10）respectively,without statistical differences.Conclusion This study suggested that IAIC is an effective and safety method compared with IVC or S alone in improving radical resection rate and survival rate
出处
《肿瘤防治研究》
CAS
CSCD
北大核心
2012年第9期1098-1106,共9页
Cancer Research on Prevention and Treatment
基金
甘肃省科技厅科技创新团队资助项目(09877CA009)
关键词
动脉化疗
静脉化疗
手术治疗
胃癌
Intraarterial infusion chemotherapy； Intravenous chemotherapy； Operation； Gastric carcinoma
