摘要
目的:系统评价 2 种化疗药联合治疗中国人群胃癌的疗效.方法:计算机检索 PubMed、Embase、Web of Science、the Cochrane Library、中国知网、中国生物医学文献数据库、万方数据库和维普数据库,搜集国内外公开发表的含替吉奥、奥沙利铂、顺铂、卡培他滨、伊立替康、多西他赛两药联合的化疗方案治疗胃癌的临床研究.检索时限均为建库至 2022 年 4 月 1 日.采用RevMan 5.4 软件进行偏倚评价,采用Stata 14.2 软件进行网状Meta分析.结果:共纳入 132 项研究,均为双臂临床试验,包括9680 例患者,涉及 10 种药物组合,分别为XELOX方案(奥沙利铂+卡培他滨)、SOX方案(奥沙利铂+替吉奥)、SP方案(替吉奥+顺铂)、XP方案(顺铂+卡培他滨)、DP 方案(顺铂+多西他赛)、DX方案(卡培他滨+多西他赛)、DS方案(替吉奥+多西他赛)、OXA+DOC方案(奥沙利铂+多西他赛)、CapIRI方案(卡培他滨+伊立替康)、S-1+IRI方案(替吉奥+伊立替康).网状Meta分析结果显示,有效率从高至低依次为DS方案、SOX方案、S-1+IRI方案、CapIRI方案、XELOX方案、OXA+DOC方案、DX方案、SP方案、DP方案、XP方案,其中DS方案、SOX方案、XELOX方案的有效率优于SP方案、XP方案,差异有统计学意义(P<0.05);疾病控制率从高至低依次为SOX方案、OXA+DOC方案、DS方案、XELOX方案、CapIRI方案、SP方案、DX方案、S-I+IRI方案、DP方案、XP方案,其中DS方案、SOX方案、XELOX方案的疾病控制率优于XP方案,差异有统计学意义(P<0.05).DS方案的贫血、肾毒性发生率最低,SOX方案的白细胞减少、腹泻发生率最低,XELOX方案的血小板减少发生率最低.DX方案的恶心呕吐、口腔炎、肝毒性发生率最低,DP方案的神经毒性发生率最低,SP方案的手足综合征发生率最低.结论:现有证据表明,化疗药组合SOX方案、DS方案、XELOX方案、S-1+IRI方案、CapIRI方案在有效率和疾病控制率方面的效果均相对较好,XP方案在有效率和疾病控制率方面均相对最差.
Abstract
OBJECTIVE:To systematically review the efficacy of combination of two chemotherapeutic drugs in the treatment of gastric cancer in Chinese population.METHODS:PubMed,Embase,Web of Science,the Cochrane Library,CNKI,CBM,Wanfang Data and VIP were retrieved to collect clinical studies on the treatment of gastric cancer with the combination of S-1,oxaliplatin,cisplatin,capecitabine,irinotecan and docetaxel published at home and abroad.The retrieval time was from the database establishment to Apr.1st,2022.RevMan 5.4 software was used for bias evaluation,and Stata 14.2 software was used for network Meta-analysis.RESULTS:A total of 132 studies(dual-arm clinical trials)including 9680 patients and 10 drug combinations were enrolled,respectively XELOX regimen(oxaliplatin+capecitabine),SOX regimen(oxaliplatin+S-1),SP regimen(S-1+cisplatin),XP regimen(cisplatin+capecitabine),DP regimen(cisplatin+docetaxel),DX regimen(capecitabine+docetaxel),DS regimen(S-1+docetaxel),OXA+DOC regimen(oxaliplatin+docetaxel),CapIRI regimen(capecitabine+irinotecan),and S-1+IRI regimen(S-1+irinotecan).Results of network Meta-analysis showed that the effective rates from high to low were DS regimen,SOX regimen,S-1+IRI regimen,CapIRI regimen,XELOX regimen,OXA+DOC regimen,DX regimen,SP regimen,DP regimen and XP regimen,the effective rates of DS regimen,SOX regimen and XELOX regimen were better than those of SP regimen and XP regimen,the differences were statistically significant(P<0.05).The disease control rate from high to low was SOX regimen,OXA+DOC regimen,DS regimen,XELOX regimen,CapIRI regimen,SP regimen,DX regimen,S-I+IRI regimen,DP regimen and XP regimen,the disease control rates of DS regimen,SOX regimen and XELOX regimen were better than those of XP regimen,the differences were statistically significant(P<0.05).DS regimen had the lowest incidence of anemia and nephrotoxicity,SOX regimen had the lowest incidence of leukopenia and diarrhea,XELOX regimen had the lowest incidence of thrombocytopenia.DX regimen had the lowest incidence of nausea,vomiting,stomatitis and hepatotoxicity,DP regimen had the lowest incidence of neurotoxicity,and SP regimen had the lowest incidence of hand-foot syndrome.CONCLUSIONS:Available evidence suggests that the chemotherapeutic combination of SOX regimen,DS regimen,XELOX regimen,S-1+IRI regimen and CapIRI regimen are effective in terms of both efficiency and disease control rate,and XP regimen is the worst in terms of both efficiency and disease control rate.
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