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

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.

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链接本文: https://journal03.magtech.org.cn/Jweb_sdykdxxb/CN/10.3969/j.issn.1006-7795.2013.03.019

https://journal03.magtech.org.cn/Jweb_sdykdxxb/CN/Y2013/V34/I3/422

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