【摘要】 【目的】Meta分析提示吉西他滨(GEM)联合化疗一线治疗晚期胰腺癌优于标准的GEM单药化疗,在此基础上进行亚组生存结果的meta分析及资料更新,旨在寻找确切有效的化疗方案。【方法】通过MEDLINE、EMBASE、ASCO、ECCO等数据库及论文集检索相关文献。按纳入标准筛选新增文献并进行资料更新。主要对各亚组进行半年生存率、其次是1年生存率的meta分析。【结果】17个随机对照临床试验(RCT)共3 821例患者纳入分析,按化疗方案分为GEM联合顺铂(GEMDDP)、GEM固定剂量率输注联合奥沙利铂(GEMOX)、联合5FU(GEMFU)、联合卡培他滨(GEMCAP)以及联合伊立替康(GEMIRI)等5个亚组,各亚组半年生存率的治疗优势(RD)分别为5%(P=0.24)、9%(P=0.005)、2%(P=0.46)、7%(P=0.03)和-1%(P=0.88);1年生存率RD为6%(P=0.11)、5%(P=0.07)、4%(P=0.19)、5%(P=0.08)和0(P=0.97)。【结论】现有的证据提示GEMOX、GEMCAP联合化疗方案一线治疗晚期胰腺癌,有较好的应用前景,值得进一步的临床试验。更多还原

【Abstract】 【Objective】 Previous meta-analyses had shown gemcitabie(GEM)-based combination chemotherapy was superior to GEM monotherapy for advanced pancreatic cancer(APCa),Subgroup analyses were performed using updated information to seek for the exactly effective GEM-based combination regimen to benefit patients with APCa.【Methods】 Subgroup meta-analyses of all previously published or unpublished studies were performed with a comprehensive search of the updated literature including MEDLINE,EMBASE,ASCO and ECCO.The analyses included all randomized evidence to compare GEM combination chemotherapy with GEM alone with respect to 6-month survival rate(6-mo SR) and 1-year survival rate(1-y SR) in APCa patients.【Results】 Seventeen RCTs involving 3821 patients were included in this meta-analysis,which were divided into five subgroups according to the combination chemotherapy regimen,GEM plus cisplatin(GEMDDP),fixed-dose rate infusion of GEM plus oxaliplatin(GEMOX),GEM plus 5-fluorouracil(GEMFU),GEM plus capecitabine(GEMCAP) and GEM plus irinotecan(GEMIRI).Subgroup analyses showed the risk difference(RD) of 6-mo SR were 5%(P=0.24),9%(P=0.005),2%(P=0.46),7%(P=0.03) and-1%(P=0.88),respectively;and the 1-y SR 6%(P=0.11),5%(P=0.07),4%(P=0.19),5%(P=0.08),and 0%(P=0.97),respectively.【Conclusion】 Based on the available evidence,GEMOX and GEMCAP regimens may be considered promising regimen as the front-line therapy for APCa,which encourages further clinical trials.更多还原