华西医学

华西医学

胃癌根治性切除术后辅助化学治疗开始时间的 Meta 分析

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目的探讨胃癌根治性切除术后辅助化学治疗(化疗)开始的最佳时间。 方法计算机检索 PubMed、Embase、中国知网、万方、维普数据库,查找国内外公开发表的关于胃癌根治性切除术后辅助化疗开始时间的临床研究,检索时间均为从建库至 2018 年 5 月 1 日,同时追溯纳入研究的参考文献。由 2 位研究者按照纳入与排除标准独立进行文献筛选、资料提取和质量评价,应用 Stata 14 软件对数据进行 Meta 分析。 结果最终纳入 10 个临床研究,9 个研究对总生存期(overall survival,OS)进行报告,其中以 4 周为开始时间分界点的研究有 3 个,以 6 周为开始时间分界点的研究有 4 个,以 8 周为开始时间分界点的研究有 2 个;4 个研究对无病生存期(disease-free survival,DFS)进行报告。Meta 分析结果显示:4 周之内开始进行辅助化疗 OS 明显优于超过 4 周开始辅助化疗[风险比(hazard ratio,HR)=0.42,95% 置信区间(confidence interval,CI)(0.27,0.65),P<0.001],而在 6 周及 8 周内开始辅助化疗 OS 均无明显获益[HR=0.91,95%CI(0.66,1.26),P=0.577;HR=1.02,95%CI(0.91,1.14),P=0.744]。关于 DFS,因纳入研究未给出统一的辅助化疗开始时间,不能进行合并分析,Meta 无法得出 DFS 与辅助化疗开始时间的相关性。 结论胃癌根治性切除术后 4 周之内开始辅助化疗可明显延长 OS。

ObjectiveTo explore the proper time to initiation of adjuvant chemotherapy after radical resection for gastric cancer. MethodsWe searched electronically in PubMed, Embase, China National Knowledge Infrastructure, Wangfang database, and Chongqing VIP database for all relevant studies published before May 1st, 2018. The references included in eligible trials were also searched. All eligible studies were assessed and evaluated by two investigators working independently. The Meta-analysis was conducted using Stata 14 software. ResultsOur literature search included a total of 10 studies. There were 9 studies reporting overall survival (OS), in which 3 studies used a 4-week cutoff for delay from surgery to adjuvant chemotherapy, 4 shared a 6-week cutoff, and 2 studies shared an 8-week cutoff. There were 4 studies reporting disease-free survival (DFS). Initiating adjuvant chemotherapy beyond 4 weeks after surgery was significantly associated with worse OS [hazard ratio (HR)=0.42, 95% confidence interval (CI) (0.27, 0.65), P<0.001]. No significant benefit was found by starting adjuvant chemotherapy within 6 weeks or 8 weeks after surgery [HR=0.91, 95%CI (0.66, 1.26), P=0.577; HR=1.02, 95%CI (0.91, 1.14), P=0.744; respectively]. Four trials reporting DFS did not share a same cutoff delay from surgery to adjuvant chemotherapy, thus it was impossible to conduct a combined Meta-analysis. ConclusionThe initiation of adjuvant chemotherapy within 4 weeks after radical resection for gastric cancer may obtain better OS.

关键词: 胃癌; 术后辅助化疗开始时间; Meta 分析

Key words: Gastric cancer; Time to initiation of adjuvant chemotherapy; Meta-analysis

引用本文: 颜若难, 刘芳, 曾圆圆, 何涛, 向中正, 刘磊. 胃癌根治性切除术后辅助化学治疗开始时间的 Meta 分析. 华西医学, 2018, 33(12): 1479-1485. doi: 10.7507/1002-0179.201810074 复制

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