吉西他滨和顺铂联合用药治疗晚期胰腺癌患者利弊的Meta分析  

The gemcitabine plus cisplatin is not beneficial for patients with advanced pancreatic cancer:Meta analysis

作　　者：周天义 贺小会 谭志辉[1] 张先林[1] Zhou Tianyi;He Xiaohui;Tan Zhihui;Zhang Xianlin(Department of General Surgery,Renhe Hospital,China Three Gorges University,Hubei Yichang 443000,China)

机构地区：[1]三峡大学附属仁和医院普外科

出　　处：《现代肿瘤医学》2019年第14期2546-2552,共7页Journal of Modern Oncology

摘　　要：目的:通过Meta分析,探讨吉西他滨和顺铂联合与吉西他滨单药治疗晚期胰腺癌的优缺点。方法:计算机检索中国知网、维普、万方数据库及中国生物医学数据库、PubMed、Sciencedirect、Embase、Cochrane Database、OVID Medline、Springer Link、EBSCO数据库,筛选观察组为吉西他滨与顺铂联合用药,对照组为吉西他滨单药治疗晚期胰腺癌的试验。检索期限为建库至2018年3月31日,同时手工查阅检索相似文献及参考文献。以上资料均由两位研究者独立进行文献筛选和资料提取,采用Review Manager 5.3软件进行Meta分析,计算结果以HR或OR值及95%置信区间(95%CI)表示。结果:共纳入文献12篇,包括观察组850例和对照组753例。Meta分析结果显示:疗效方面,总生存期、1年生存率及半年生存率方面吉西他滨和顺铂联合用药与吉西他滨单独用药无明显区别[HR总生存期=0.97, 95%CI为(0.83,1.12),P=0.65>0.05;OR1年生存率=1.02, 95%CI为(0.76,1.38),P=0.89>0.05;OR半年生存率=1.12,95%CI为(0.77,1.64),P=0.56>0.05];而客观缓解率(ORR)则具有边缘性统计意义[OR客观缓解率=1.54,95%CI为(1.00,2.37),P=0.05];毒副反应方面,吉西他滨和顺铂联合用药的毒副作用明显高于吉西他滨单独用药[OR3/4度中性粒细胞减少=1.70,95%CI为(1.27,2.27),P=0.000 4<0.05;OR3/4度血小板减少=1.96,95%CI为(1.55,2.49),P<0.000 01;OR胃肠道毒副作用=2.98,95%CI为(1.95,4.55),P<0.000 01]。结论:吉西他滨联合顺铂治疗晚期胰腺癌虽然在ORR中能使患者受益,但不能使患者获得比单用吉西他滨更好的临床疗效及远期预后,反而使中性粒细胞减少、血小板减少及胃肠道反应等毒副反应加剧。因此,临床上不应提倡吉西他滨联合顺铂用药作为一线临床用药,应选用更加合理有效的化疗用药方案。Objective:To explore the advantages and disadvantages of gemcitabine plus cisplatin and gemcitabine alone in the treatment of advanced pancreatic cancer by Meta analysis.Methods:The clinical trial of observation group was the gemcitabine plus cisplatin,and the control group was the gemcitabine alone,which were serached by computer retrieval on CNKI,VIP,Universal database,Chinese biomedicine database,PubMed,Sciencedirect,Embase,the Cochrane database,OVID medline,Springer Link,EBSCO database.The retrieval time was from building libraries to March 31,2018.At the same time,the similar literatures and references were searched manually,and the results were expressed in HR or OR values and 95%CI.Results:Total of 12 literatures were included,including 850 cases in the observation group and 753 in the control group.Meta analysis showed:there was no significant difference in the OS(overall survival),one year survival rate,six-month survival rate between gemcitabine plus cisplatin and gemcitabine alone [OROS= 0. 9 7,9 5 % CI( 0. 83,1. 12),P = 0. 65 > 0. 05,ORone year survival rate= 1. 02,95% CI( 0. 76,1. 38),P= 0. 89 > 0. 05,ORsix-month survival rate= 1. 12,95% CI( 0. 77,1. 64),P = 0. 56 > 0. 05]. ORR had marginal statistical significance [ORORR= 1. 54,95% CI( 1. 00,2. 37),P = 0. 05]. The toxic side effect of gemcitabine plus cisplatin was significantly higher than that of gemcitabine alone[OR3/4 degree neutrophil reduction= 1. 70,95% CI( 1. 27,2. 27),P = 0. 000 4< 0. 05,OR3/4 degree thrombocytopenia= 1. 9 6,9 5 % CI( 1. 5 5,2. 4 9),P < 0. 000 01,ORgastrointestinal side effects= 2. 98,95% CI( 1. 95,4. 55),P < 0. 000 01]. Conclusion: Gemcitabine plus cisplatin treatment of advanced pancreatic cancer can benefit patients in the ORR,but cannot make compared with gemcitabine alone in patients with better clinical curative effect and long-term prognosis,but aggravate adverse reactions such as neutropenia,thrombocytopenia,and gastrointestinal reaction etc. Therefore,it should not be recommended that gemcitabine combined with cisp

关 键 词：胰腺癌 吉西他滨 顺铂 META分析 

分 类 号：R735.9[医药卫生—肿瘤]