Oxaliplatin-based versus cisplatin-based chemotherapy as first-line treatment in advanced gastric cancer: a meta-analysis.
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摘要:
目的探讨奥沙利铂与顺铂治疗进展期胃癌的疗效、预后及不良反应的优劣。 方法检索中国知网（CNKI）、万方、PubMed/ Medline、Embase/Ovid、Cochrane Library、历年美国临床肿瘤学会（ASCO）和欧洲肿瘤内科学会（EMSO）年会文献汇编及北美临床试验注册网。评价指标为总体生存期（OS）、无进展生存期（FPS）、客观缓解率（ORR）及严重不良反应。 结果纳入32篇文献，共3994位患者参与(奥沙利铂组1992例，顺铂组2002例）。采用含奥沙利铂方案的总生存期（HR=0.90, 95%CI 0.81~0.99）、无进展生存期（HR=0.89, 95%CI 0.81~0.98）、有效率（OR=1.33, 95%CI 1.17~1.51）明显优于顺铂组。白人亚组和亚洲人种亚组均受益于含奥沙利铂的化疗方案（OR=1.55, 95%CI 1.05~2.01）。严重不良反应方面奥沙利铂方案较少发生的贫血(OR=0.49, 95%CI 0.38~0.62）、白细胞减少（OR=0.37, 95%CI 0.27~0.51）、中性粒细胞减少（OR=0.49, 95%CI 0.40~0.59）等骨髓抑制，易发生严重的恶心/呕吐（OR=0.37, 95%CI 0.21~0.61）和周围神经病变（OR=7.16, 95%CI 4.06~12.64），差异有统计学意义。 结论与顺铂方案相比，奥沙利铂方案具有较好的疗效与预后，不良反应相对较少，可被推荐和替代顺铂用于治疗进展期胃癌。未来需要大样本高质量的研究提供更多信息进一步探讨不同因素对两种方案的影响。 Abstract:Objective To evaluate the efficacy, prognosis and safety of oxaliplatin-based chemotherapy regimens versus cisplatin-based chemotherapy regimens as first-line treatment in patients with advanced gastric cancer. Methods A comprehensive literature search (up to December 31, 2014) was performed in CNKI, WangFang, Medline/PubMed, Embase/ Ovid and Cochrane Library. We also searched abstracts present at the conferences of ASCO and EMSO annual meeting and relevant clinical trials from clinical trial registry of North America (www.clinicaltrials.gov). Primary outcomes were overall survival (OS), overall response rate (ORR) and grade 3-4 toxicities. Results Thirty-two randomized controlled trial (RCTs) were included and 3994 patients were analyzed (1992 in oxaliplatin-based regimen and 2002 in cisplatin-based regimen). The meta-analysis showed that oxaliplatin-based regimen significantly prolong the OS (HR=0.90, 95%CI 0.81-0.99) and FPS (HR=0.89, 95% CI 0.81-0.98) compare to cisplatin-based regimen. Pooled estimate demonstrated that ORR of oxaliplatin-based regimen was superior (OR=1.33, 95%CI 1.17-1.51), similar trend was drawn in Asian patients subgroup and Caucasian patients subgroup. In grade III or IV toxicities, oxalipaltin-based regimen had a lower incidence of anemia (OR=0.49, 95%CI 0.38-0.62), leucopenia (OR=0.37, 95% CI 0.27-0.51), neutropenia (OR=0.49, 95% CI 0.40-0.59), but nausea/vomiting (OR=0.37, 95% CI 0.21-0.61) and peripheral neuropathy (OR=7.16, 95%CI 4.06-12.64) occurred commonly. All above had statistical significant. Conclusion Oxaliplatin-based regimen have better efficacy prognosis and fewer toxicities compared with cisplatin-based regimen, can be recommended and replace cisplatin for advanced gastric cancer. More large size and high quality RCTs need to confirm the results and provide more information in comparing the two regimens. -
Key words:
- oxaliplatin /
- cisplatin /
- advanced gastric cancer /
- chemotherapy /
- meta-analysis
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表 1 严重不良反应效应量合并结果
不良反应 实验组 对照组 异质性 OR(95%CI) P P I2 恶心/呕吐 137/1582 237/1620 <0.00001 0.65 0.37(0.21, 0.61) <0.0001 口角炎 32/1177 28/1196 0.21 24% 1.03(0.51, 2.08) 0.92 腹泻 111/1192 75/1223 0.02 0.5 1.49(0.86, 2.59) 0.15 贫血 124/1159 225/1164 0.58 0 0.49(0.38, 0.62) <0.00001 白细胞减少 60/938 145/944 0.13 0.31 0.37(0.27, 0.51) <0.00001 中性粒细胞减少 270/1112 440/1130 0.11 0.39 0.49(0.40, 0.59) <0.00001 血小板减少 73/1131 80/1140 0.95 0 0.92(0.66, 1.28) 0.64 周围神经炎 89/1202 11/1223 0.84 0 7.16(4.06, 12.64) <0.00001 乏力 120/965 116/983 0.02 0.63 1.01(0.58, 1.74) 0.99 脱发 140/690 238/697 0.96 0 0.47(0.36, 0.60) <0.00001 
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