吉西他滨联合奥沙利铂对胆管癌疗效的Meta分析  

Efficacy of gemcitabine plus oxaliplatin agents for biliary tract cancers：a meta-analysis

作　　者：杨锐[1] 李红波[1] 王兵[1] 邹声泉[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院普外科,武汉430030

出　　处：《临床外科杂志》2014年第3期156-159,共4页Journal of Clinical Surgery

基　　金：中国高新技术研究发展计划资助（863计划）（项目编号：2010DFA31870）

摘　　要：目的 分析吉西他滨＋奥沙利铂治疗进展期胆管癌（BTC）的效果.方法 联合应用PubMed、Medline、Embase和谷歌学术搜索,搜索词条为：吉西他滨、奥沙利铂、胆管癌、胆道、胆囊、胆管.凡是应用吉西他滨＋奥沙利铂治疗进展期（不能切除或者转移的）BTC、属于随机对照临床试验的研究均纳入研究范畴.治疗结果的分析包括反应率（RR）,总生存率（OS）,无进展生存时间（PFS）.合并比值比（ORs）、中位生存期的差异以及95%可信区间（CIs）用于治疗结果的判断.结果 最初有47篇文献纳入研究,最终三个开放的随机对照试验（两个Ⅱ期,一个Ⅲ期）符合标准并进行Meta分析.其中两个研究比较吉西他滨＋奥沙利铂与单用吉西他滨的效果,另一个研究对吉西他滨＋奥沙利铂或氟尿嘧啶-亚叶酸作比较.研究中纳入的患者总数从54～410例.分析显示联合应用吉西他滨和奥沙利铂的患者可以获得更好的临床效果.RR：OR=2.639,95% CI=1.210～5.757,Z=2.439,P=0.015;中位生存期差异（OS）=3.822个月,95% CI=1.798～5.845个月,Z=3.702,P＆lt;0.001;无进展生存差异（PFS）=3.268个月,95% CI=1.996～4.541个月,Z=5.035,P＆lt;0.001.结论 在进展期BTC中,吉西他滨＋奥沙利铂的联合化疗较其他的化疗方案可以提高存活率.Objective To evaluate the efficacy of gemcitabine ＋ oxaliplatin regimens in the treatment of advanced biliary tract cancer （ BTC ）. Methods The terms “ gemcitabine”,“ oxaliplatin”, “cholangiocarcinoma”, “biliary”, “gallbladder” and “bile duct” were used to search PubMed, Medline, Embase and Google Scholar. All randomized trials using gemcitabine ＋ oxaliplatin for advanced （ unresectable or metastatic cancer ） BTC were included. Response rate （ RR）, overall survival （ OS）, progression-free survival （ PFS）, odds ratios （ ORs）, median survival and 95 % confidence intervals （CIs） were analyzed to evaluate outcomes. Results Forty-seven records were identified in the initial search. Ultimately, three open randomized trials（ two phase 2 and one phase 3 ）were included in the meta-analysis. Two studies involved comparing gemcitabine ＋ oxaliplatin with gemcitabine alone, and the other study compared gemcitabine ＋ oxaliplatin with fluorouracil plus folinic acid. The total number of patients ranged from 54 to 410. The resuits revealed that the patients treated with gemcitabine ＋ oxaliplatin showed better outcomes. RR： OR = 2. 639,95 % CI = 1.210 to 5. 757, Z = 2. 439 ; P = 0.015 ; pooled difference in median OS - 3. 822months, 95% CI = 1. 798 to 5. 845 months, Z = 3. 702, P 〈 0. 001 ; pooled difference in median PFS = 3. 268 months,95% CI = 1. 996 to 4. 541 months,Z = 5. 035,P 〈 0. 001. Conclusion Advanced BTC patients treated with gemcitabine ＋ oxaliplatin may get better outcomes than with other chemotherepy regimens.

关 键 词：胆管癌 有效性 吉西他滨 奥沙利铂 META分析 

分 类 号：R735.8[医药卫生—肿瘤]