【摘要】 目的 采用网状Meta分析法比较基于不同周期多西他赛为基础的围手术期化疗方案对局部晚期胃癌（LAGC）和胃食管交界处癌（GEJC）的疗效与安全性。方法 计算机检索PubMed、Embase、Cochrane Library和Web of Science数据库，搜集以多西他赛为基础的围手术期方案治疗LAGC和GEJC的随机对照试验（RCT），检索时限均从建库至2025年2月28日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用R 4.5.0软件进行网状Meta分析。结果 最终纳入10个RCT，包括2 064例患者。网状Meta分析结果显示，与3个周期的表柔比星、环磷酰胺和氟尿嘧啶（ECF方案）和4个周期的铂类和氟尿嘧啶（PF方案）相比，3个周期的多西他赛、铂类和氟尿嘧啶（TPF方案）和4个周期TPF方案可提高肿瘤完全切除率（R0切除率）；与单纯手术相比，3个周期TPF方案可显著提高R0切除率。与2个周期PF方案相比，4个周期TPF方案可显著改善3年、5年的无进展生存期（PFS）。与3个周期ECF方案相比，4个周期TPF方案可显著改善3年、5年的总生存期（OS）。与单纯手术相比，3个周期TPF方案可显著改善病理完全缓解率（pCR率）。与2个周期TPF方案、3个周期ECF方案相比，4个周期TPF和PF方案能明显降低手术并发症发生率；与单纯手术相比，2个周期TPF方案、3个周期ECF方案会明显增加手术并发症的发生风险。在3～4级不良事件发生率方面，每种治疗方案间差异均无统计学意义（P > 0.05）。累积排序概率曲线下面积（SUCRA）及配对比较显示，3个周期PF方案可能是与最佳的R0切除率相关的围手术期化疗方案；3个周期TPF方案可能是与最佳的pCR率相关的围手术期化疗方案；4个周期TPF方案可能是与最佳的3年PFS、3年OS、5年PFS和5年OS相关的围手术期化疗方案。结论 4个周期TPF方案可能是与最佳的PFS和OS相关的围手术期化疗方案，而4个周期TPF方案与3个周期PF方案在R0切除率方面、与3个周期TPF方案在pCR率方面、与纳入研究的其他7个方案在安全评估方面差异均无统计学意义。4个周期TPF方案可能是LAGC和GEJC患者的最优围手术期化疗方案。更多还原

【Abstract】 Objective To compare the efficacy and safety of perioperative chemotherapy regimens based on docetaxel administered in different cycles for locally advanced gastric cancer(LAGC) and gastroesophageal junction cancer(GEJC) through a network Meta-analysis. Methods PubMed, Embase, Cochrane Library, and Web of Science databases were electronically searched to collect randomized controlled trials(RCTs) evaluating docetaxel-based perioperative regimens for the treatment of LAGC and GEJC from inception to February 28, 2025. Two researchers independently screened the literature, extracted relevant data, and assessed the risk of bias in the included studies. Subsequently, a network Meta-analysis was performed using R 4.5.0 software. Results A total of 10 RCTs involving 2,064 patients were included. The results of the network Meta-analysis showed that, compared with three cycles of epirubicin, cyclophosphamide, and fluorouracil(ECF regimen) and four cycles of platinum and fluorouracil(PF regimen), both three-cycle and four-cycle docetaxel, platinum, and fluorouracil(TPF regimen) significantly increased the complete tumor resection rate(R0 resection rate). Compared with surgery alone, the three-cycle TPF regimen significantly improved the R0 resection rate. Additionally, the four-cycle TPF regimen significantly improved 3-year and 5-year progression-free survival(PFS) compared with the two-cycle PF regimen, and significantly improved overall survival(OS) at 3 and 5 years compared with the three-cycle ECF regimen. Compared with surgery alone, the three-cycle TPF regimen also significantly increased the pathological complete response rate(pCR rate). Furthermore, compared with the two-cycle TPF and three-cycle ECF regimens, the four-cycle TPF and PF regimens were associated with a lower risk of surgical complications. Conversely, the two-cycle TPF and three-cycle ECF regimens significantly increased the risk of surgical complications compared with surgery alone. No statistically significant differences were observed in the incidence of grade 3 to 4 adverse events among the treatment regimens(P>0.05). Based on the surface under the cumulative ranking curve(SUCRA) plot and pairwise comparisons, the three-cycle PF regimen appeared to be the most effective in achieving the highest R0 resection rate, the three-cycle TPF regimen appeared to be the most effective in achieving the highest pCR rate, while the four-cycle TPF regimen was associated with the best outcomes in terms of 3-year and 5-year PFS and OS. Conclusion The four-cycle TPF regimen may be associated with the optimal PFS and OS among perioperative chemotherapy regimens. No statistically significant differences were observed between the four-cycle TPF and the three-cycle PF in terms of R0 resection rate, between the four-cycle TPF and the three-cycle TPF in terms of pCR rate, or between the fourcycle TPF and the other seven regimens included in the study in terms of safety assessment. The four-cycle TPF regimen may represent the optimal perioperative chemotherapy regimen for patients with LAGC and GEJC.更多还原