氟尿嘧啶和铂类联合赫赛汀或蒽环类药物一线治疗晚期胃癌:基于发表文献的间接比较  

Fluorouracil plus cisplatin combined with trastuzumab or anthracyclines as a first-line therapy for advanced gastric cancer:an indirect comparison based on published literatures

作　　者：魏莹[1] 叶升[2] 杨琼[1] 江志敏[1] 周思维[1] 陈燕贤[1] 谢德荣[1] 

机构地区：[1]中山大学孙逸仙纪念医院肿瘤科,广州510120 [2]中山大学附属第一医院肿瘤科

出　　处：《中华普通外科学文献（电子版）》2012年第6期60-64,共5页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的晚期胃癌中曲妥珠单抗或蒽环类联合顺铂、氟尿嘧啶类的三药方案(HCF或ECF)疗效均优于顺铂联合氟尿嘧啶类两药方案(CF),但两者之间没有头对头的直接比较。本间接比较试图探索HCF与ECF的相对疗效。方法由2位评价者通过数据库电子检索以及手工检索相关文献,选择HCF与ECF比较或HCF与CF比较或ECF与CF比较的前瞻性随机对照临床试验(RCT)或Meta分析。选择总生存期为研究终点指标,通过Bucher校正间接比较法比较HCF方案对比ECF方案的相对死亡风险。结果共有2个研究纳入分析,1项RCT涉及HCF与CF方案比较,1个Meta分析涉及ECF与CF方案比较。用Bucher间接比较法比较HCF与ECF方案,两者总生存差异无统计学意义(HR=0.96,95%CI=0.71～1.30,P=0.79),而在Her-2低表达组(IHC0～+)(HR=1.39,95%CI=0.87～2.23,P=0.17)和Her-2高表达组(IHC++～+++)(HR=0.84,95%CI=0.61～1.17,P=0.31)差异亦均无统计学意义。结论间接比较结果提示HCF方案并不优于ECF方案,但由于间接比较存在局限性,需要临床进一步验证。Objective Both Trastuzumab and anthracyclines in combination with cisplatin and fluoropyrimidine triplet regimen （HCF or ECF） are superior to cisplatin and fluoropyrimidine doublet regimen （CF） in treating advanced gastric cancer, but there is no direct comparison between HCF and ECF. This paper is to explore the relative efficacy of HCF versus ECF. Methods Two reviewers performed a comprehensive search of all previously published or unpublished trials through electronic databases and hand-searching. All prospective randomized clinical＇ trials （RCTs） or Meta-analysis comparing HCF with CF, or HCF with CF, or ECF with CF were selected in the present study. Overall survival was chosen as the endpoint. Relative risk of HCF to ECF was analyzed by Bucher adjusted indirect comparison. Results A RCT involving HCF versus CF regimen and a Meta analysis involving ECF versus CF regimen were selected. Comparing HCF and ECF with Burcher adjusted indirect comparison, there was no statistical difference between them（HR = 0.96, 95% CI = 0.71 to 1.30, P = 0.79）, and there were also no statistical differences in low Her-2 expression subgroup （IHC 0 - ＋） （HR = 1.39, 95% CI = 0.87 to 2.23, P = 0.17） and high Her-2 expression subgroup （IHC ＋＋ - ＋＋＋）（HR = 0.84, 95% CI = 0.61 to 1.17, P = 0.31）. Conclusions The results of indirect comparison indicated that HCF regimen was not superior to ECF regimen. And due to the limitations of indirect comparison, clinical comparisons between HCF and ECF are needed.

关 键 词：晚期胃癌 化学治疗 间接比较 曲妥珠单抗 蒽环类药物 

分 类 号：R735.2[医药卫生—肿瘤]