XELOX方案与FOLFOXs方案治疗中国晚期胃癌患者的Meta分析

doi:10.3969/j.issn.1006-7795.2013.03.019

首都医科大学学报 ›› 2013, Vol. 34 ›› Issue (3): 422-427.doi: 10.3969/j.issn.1006-7795.2013.03.019

XELOX方案与FOLFOXs方案治疗中国晚期胃癌患者的Meta分析

张瑞雪¹, 闫涵¹, 王民², 金启成¹, 杨薏帆¹, 曹邦伟¹

1. 首都医科大学附属北京友谊医院肿瘤科,北京 100050;
2. 首都医科大学附属北京友谊医院消化科, 北京 100050

收稿日期:2012-11-07 出版日期:2013-06-21 发布日期:2013-06-17
通讯作者: 曹邦伟 E-mail:oncologychina@163.com
基金资助:
北京市"215" 高层次卫生人才资助项目(2011－0701),北京市"十百千"人才资助项目(2011－0101)。

A Meta-analysis on the effects of regimen XELOX versus FOLFOXs for treatment of Chinese patients with metastatic gastric cancer

ZHANG Ruixue¹, YAN Han¹, WANG Min², JIN Qicheng¹, YANG Yifan¹, CAO Bangwei¹

1. Department of Oncology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China;
2. Department of Digestive, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

Received:2012-11-07 Online:2013-06-21 Published:2013-06-17
Supported by:
This study was supported by the Foundation of"215" Beijing Health System (2011-0701), Health and Technical Personnel of High-Level Plan (2011-0101).

摘要/Abstract

摘要：

目的目前临床晚期胃癌的化疗中以氟尿嘧啶类+奥沙利铂的方案选择较多,本文拟评价XELOX(卡培他滨+奥沙利铂)方案与FOLFOXs(5－氟尿嘧啶+亚叶酸钙+奥沙利铂)方案治疗中国晚期胃癌人群的疗效差异,并同时做出该2种方案的安全性评价。方法在CNKI、万方、维普、Pubmed数据库中,检索XELOX和FOLFOXs 2组方案治疗晚期胃癌的随机对照临床试验(randomized controlled trial,RCT),按照Jadad质量计分法对所纳入的每篇文献逐篇进行方法学质量评估;纳入患者均为局部晚期或转移性胃癌的中国人群;荟萃分析采用Meta分析专用软件 Review Manager Version 5.0和 Stata 10.0 软件进行系统评价,评价内容为2种化疗方案的有效性(即临床缓解率,PR+CR)与安全性,利用Egger's test评价发表偏倚。结果共有13个临床研究纳入本系统评价(总计783例中国晚期胃癌患者),其中应用XELOX方案化疗患者398例,该组临床缓解率为53.52%;而应用FOLFOXs方案患者385例,该组临床缓解率为45.71%,2组比较其比值比(odd ratio, OR)为1.18 (95%CI: 1.02~1.35, P=0.03)。在不良反应即安全性评价方面,XELOX方案较之FOLFOXs方案恶心、呕吐及腹泻的发生率明显减低(P<0.05),手足综合征发生率略有增加(P<0.01),而对于白细胞减少、贫血、血小板减少、周围神经损伤、口腔炎等的发生率差异无统计学意义(P>0.05)。Egger's test显示无显著性发表偏倚(P=0.993)。结论在局部晚期或转移性胃癌中国患者的临床治疗中,XELOX方案在临床缓解率方面优于FOLFOXs方案,而且其不良反应的发生率亦略低于FOLFOXs方案。

关键词: 胃癌, XELOX, FOLFOXs, Meta分析

Abstract:

Objective Fluoropyrimidine combined with oxaliplatin were often used to treat the metastasis gastric cancer. In this paper, the clinical outcome and adverse reactions will be compared between the regimens XELOX and FOLFOXs for chemotherapy of metastasis gastric cancer in Chinese population.Methods The original articles on randomized controlled trials (RCTs) comparing the chemotherapy of XELOX and FOLFOXs in Chinese patients with advanced gastric cancer were recruited from the PubMed, Wanfang, VIP, and CNKI databases. The quality of the selected trials was assessed by Jadad-scale method. All eligible individuals were Chinese patients who had locally advanced or metastatic gastric cancer. Meta-analysis about the efficacy and safety of the two chemotherapy methods was performed by using Revman 5.0 and Stata 10.0 software. Egger's test was used to evaluate the publication bias. Results Thirteen RCT reports, including 783 Chinese patients with advanced gastric cancer, were recruited in this study based on the selected standard. The overall response rate was 53.52% in the XELOX treatment group which included 398 patients and 45.71% in FOLFOXs group which included 385 patients; respectively (OR=1.18, 95%CI: 1.02-1.35, P=0.03). For the safety evaluation, the nausea and vomiting incidence in XELOX treatment group possessed a higher rate than in FOLFOXs group (P<0.05). But the incidence of hand-foot syndrome was lower in FOLFOXs treatment group (P<0.05). The adverse reactions such as leukopenia, anemia, thrombocytopenia, peripheral nerve injury, and stomatitis did not exhibit any significant differences between the two groups (P>0.05). The Egger's test reveled that no significant publication bias was found (P=0.993). Conclusion In the chemotherapy of advanced or metastatic gastric cancer, the clinical response rate of XELOX was higher and the incidence of adverse reactions was slightly lower compared to FOLFOXs in Chinese patients.

Key words: gastric cancer, XELOX, FOLFOXs, Meta analysis

中图分类号:

R 730.5

张瑞雪, 闫涵, 王民, 金启成, 杨薏帆, 曹邦伟. XELOX方案与FOLFOXs方案治疗中国晚期胃癌患者的Meta分析[J]. 首都医科大学学报, 2013, 34(3): 422-427.

ZHANG Ruixue, YAN Han, WANG Min, JIN Qicheng, YANG Yifan, CAO Bangwei. A Meta-analysis on the effects of regimen XELOX versus FOLFOXs for treatment of Chinese patients with metastatic gastric cancer[J]. Journal of Capital Medical University, 2013, 34(3): 422-427.

参考文献

[1] Krejs G J. Gastric cancer: epidemiology and risk factors[J]. Dig Dis, 2010, 28(4-5): 600-603.

[2] Yang D, Hendifar A, Lenz C, et al. Survival of metastatic gastric cancer: Significance of age, sex and race/ethnicity[J]. J Gastrointest Oncol, 2011, 2(2): 77-84.

[3] Bretthauer M, Kalager M. Principles, effectiveness and caveats in screening for cancer[J]. Br J Surg, 2013, 100(1): 55-65.

[4] 朱圣韬, 曹邦伟, 徐昌青,等. TIM-3基因启动子区多态性与胃癌易感的相关性研究[J]. 首都医科大学学报,2010, 31(3): 299-303.

[5] Cervantes A, Roda D, Tarazona N, et al. Current questions for the treatment of advanced gastric cancer[J]. Cancer Treat Rev, 2013, 39(1): 60-67.

[6] 曹邦伟, 于晶琳, 荷欢,等. 中国人群中HPV感染与食管癌发生关联的Meta分析[J]. 首都医科大学学报, 2010, 31(2): 258-263.

[7] Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test[J]. BMJ, 1997, 315(7109): 629-634.

[8] 陈绍俊,黄海欣,李桂生. 卡培他滨与氟尿嘧啶/亚叶酸钙联合奥沙利铂治疗晚期胃癌的随机对照临床研究[J]. 中国癌症杂志,2007, 17(6): 483-486.

[9] 胡建兵,文芳,翁洁. XELOX和OLF方案治疗晚期胃癌的随机对照临床研究[J]. 中国实用医药,2009, 4(15): 25-26.

[10] 雷俊华,洪涛,曾江正,等. XELOX方案治疗进展期胃癌临床观察[J]. 华北国防医药,2009, 21(4): 10-12.

[11] 刘风玲,郑毅琳. 奥沙利铂联合卡培他滨或氟脲嘧啶/叶酸方案治疗晚期胃癌的临床疗效比较[J]. 实用临床医药杂志,2010, 14(23): 50-51.

[12] 陆海林,李燕,宁志强,等. XELOX与FOLFOX4方案治疗晚期胃癌疗效观察[J]. 实用临床医药杂志,2011, 15(19): 112-113.

[13] 曲智锋,冯笑山,高社干,等. 奥沙利铂联合卡培他滨治疗晚期胃癌临床疗效观察[J]. 福建医药杂志,2007, 29(4): 41-43.

[14] 孙清,毛永杰,赵伟,等. 卡培他滨联合奥沙利铂治疗晚期胃癌的随机对照临床研究[J]. 肿瘤防治研究,2005, 32(11): 729-730.

[15] 王爱英,张毛讲. 卡培他滨联合奥沙利铂治疗晚期胃癌的临床观察[J]. 中国医药导报,2012, 9(6): 58-59.

[16] 王红民,程先鸣, 张明莉. 奥沙利铂加卡培他滨治疗晚期胃癌的疗效观察[J]. 中国医院用药评价与分析,2009, 9(11): 856-857.

[17] 王海忠,王湘辉,吕志诚. XELOX与FOLFOX4方案治疗进展期胃癌的随机对照临床研究[J]. 现代肿瘤医学,2010, 18(15): 947-950.

[18] 王磊,胡冰,季楚舒,等. XELOX与FLO方案治疗晚期胃癌的近期疗效及毒副反应比较[J]. 安徽医药,2011, 15(3): 329-330.

[19] 杨晶. 卡培他滨联合奥沙利铂在晚期胃癌中的临床效果研究[J]. 实用心脑肺血管病杂志,2011, 19(3): 369-370.

[20] 赵文英,吉兆宁. XELOX或FOLFOX4方案治疗晚期胃癌的随机对照分析[J]. 中国肿瘤临床,2009, 36(18): 1044-1046.

[21] Francesco M, Gina T, Claudio M, et al. Effectiveness and safety of oxaliplatin compared to cisplatin for advanced, unresectable gastric cancer: a systematic review and meta-analysis[J]. Gastric Cancer, 2011, 14(1): 50-55.

[22] Hirsch B R, Zafar S Y. Capecitabine in the management of colorectal cancer[J]. Cancer Manag Res, 2011, 3: 79-89.

[23] Kang Y K, Kang W K, Shin D B, et al. Capecitabine/cisplatin versus 5-fluorouracil/cisplatin as first-line therapy in patients with advanced gastric cancer: a randomised phase Ⅲ noninferiority trial[J]. Ann Oncol, 2009, 20(4): 666-673.

[24] Cassidy J, Clarke S, Díaz-Rubio E, et al. XELOX vs FOLFOX-4 as first-line therapy for metastatic colorectal cancer: NO16966 updated results[J]. Br J Cancer, 2011, 105(1): 58-64.

[25] Caronia D, Martin M, Sastre J, et al. A polymorphism in the cytidine deaminase promoter predicts severe capecitabine-induced hand-foot syndrome[J]. Clin Cancer Res, 2011, 17(7): 2006-2013.

[26] Azuma Y, Hata K, Sai K, et al. Significant association between hand-foot syndrome and efficacy of capecitabine in patients with metastatic breast cancer[J]. Biol Pharm Bull, 2012, 35(5): 717-724.

[27] 肖作珍,肖瑞,姜继臣.奥沙利铂联合表柔比星和5-Fu治疗多发转移性胃癌的临床观察[J].中华肿瘤防治杂志,2010,17(12):946-947.

[28] 严冬,戴红.恩度联合XELOX方案一线治疗老年晚期结直肠癌的临床观察[J].中华肿瘤防治杂志,2011,18(12):961-964.

[29] 柴慈婧,王骏飞,李罡,等.卡培他滨治疗老年晚期消化道肿瘤的临床观察[J].中华肿瘤防治杂志,2010,17(19):1571-1572,1575.

XELOX方案与FOLFOXs方案治疗中国晚期胃癌患者的Meta分析

A Meta-analysis on the effects of regimen XELOX versus FOLFOXs for treatment of Chinese patients with metastatic gastric cancer

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	苏珈仪, 刘春涛, 王铁山, 李文坤, 杨奕, 武珊珊, 李鹏, 吴静. 血清幽门螺杆菌抗体分型检测与胃黏膜病变的相关性[J]. 首都医科大学学报, 2022, 43(2): 216-220.
[2]	马宗慧, 张倩, 邢洁, 朱圣韬, 李鹏, 张澍田, 孙秀静. 早期胃癌内镜下治疗的非治愈性切除率及影响因素[J]. 首都医科大学学报, 2022, 43(1): 17-21.
[3]	宁婷婷, 徐俊玄, 刘思, 闵力, 朱圣韬. TRIM28在胃癌中表达的临床意义及对胃癌细胞侵袭和迁移的影响[J]. 首都医科大学学报, 2020, 41(4): 570-575.
[4]	宫鹏超, 李艳兰, 孔翠翠, 田昕. 蟾蜍灵通过程序性坏死途径诱导人胃癌细胞SGC-7901死亡[J]. 首都医科大学学报, 2019, 40(2): 251-256.
[5]	张雪芳, 何鑫, 黄文阳, 李卫华, 罗美, 张阳, 王淑珍. 中国女性宫颈高危型HPV感染与阴道微生态关系的Meta分析[J]. 首都医科大学学报, 2018, 39(6): 841-848.
[6]	许庆庆, 段甦, 王向东, 张罗. 鼻中隔偏曲矫正对变应性鼻炎患者治疗效果的Meta分析[J]. 首都医科大学学报, 2018, 39(6): 928-932.
[7]	孙秀静, 张倩, 邢洁, 朱敏, 郭俊峰, 曹彬, 朱圣韬, 李鹏, 张澍田. 超声内镜对早期胃癌浸润深度的诊断价值及影响因素分析[J]. 首都医科大学学报, 2018, 39(5): 669-674.
[8]	李青春, 邢莹莹, 贾萌萌, 程晓琳, 田晓予. 17β羟基类固醇脱氢酶5型和6型基因多态性与多囊卵巢综合征发病风险相关性的Meta分析[J]. 首都医科大学学报, 2018, 39(3): 404-412.
[9]	高占梅, 宋扬, 刘华, 文昌隆, 孙海洋. 氮卓斯汀鼻喷剂联合地氯雷他定治疗变应性鼻炎疗效的Meta分析[J]. 首都医科大学学报, 2018, 39(3): 458-464.
[10]	高占梅, 宋扬, 刘华, 文昌隆, 孙海洋. 甲泼尼龙与地塞米松治疗突发性耳聋疗效比较的Meta分析[J]. 首都医科大学学报, 2018, 39(2): 265-271.
[11]	蒲昌盛, 郑智, 蔡军, 唐华臻, 张军, 张忠涛. Siewert Ⅱ型食管胃结合部腺癌组织中PDZK1和PDGFR-β的表达及相互作用[J]. 首都医科大学学报, 2017, 38(6): 804-809.
[12]	刘迪, 赵中垚, 孙琦, 王友信. 抑癌DNA甲基化在乳腺癌早期筛查和辅助诊断中的价值比较：间接比较Meta分析[J]. 首都医科大学学报, 2017, 38(4): 559-565.
[13]	谭晓刚, 王若天, 姚舒洋, 支修益. XRCC1基因Arg280His多态与肺癌易感性关系的Meta分析[J]. 首都医科大学学报, 2016, 37(6): 758-762.
[14]	聂洋洋, 史志国, 陈玢, 闫涛, 郑晖. 托烷司琼与昂丹司琼预防全身麻醉术后恶心呕吐效果的比较:系统评价和Meta分析[J]. 首都医科大学学报, 2016, 37(3): 391-399.
[15]	郭水龙, 朱圣韬, 程芮, 邵琳琳, 孙秀梅, 张澍田. miR-365通过靶向E2F2抑制胃癌细胞增生和肿瘤形成[J]. 首都医科大学学报, 2016, 37(1): 1-5.