S-1单药治疗与S-1联合治疗吉西他滨难治性晚期胰腺癌疗效及安全性的Meta分析  

A Meta-analysis of efficacy and safety of S-1 monotherapy and S-1 combined treatment in treatment of gemcitabine refractory advanced pancreatic cancer

作　　者：王新慧 李祥春[1] 周保林 王雅琳[1] 钟升 王中峰[4] 刘战涛 刘子玲[1] WANG Xinhui;LI Xiangchun;ZHOU Baolin;WANG Yalin;ZHONG Sheng;WANG Zhongfeng;LIU Zhantao;LIU Ziling(Department of Oncology,the First Hospital of Jilin University,Changchun 130021,Jilin,China;Department of Gastroenterology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,He’nan,China;Department of Neurosurgery,the First Hospital of Jilin University,Changchun 130021,Jilin,China;Department of Hepatobiliary and Pancreatic Disease,the First Hospital of Jilin University,Changchun 130021,Jilin,China)

机构地区：[1]吉林大学第一医院肿瘤内科,长春130021 [2]郑州大学第一附属医院消化内科,郑州450052 [3]吉林大学第一医院神经肿瘤外科,长春130021 [4]吉林大学第一医院肝胆胰内科,长春130021

出　　处：《癌症进展》2019年第19期2321-2325,共5页Oncology Progress

摘　　要：目的评价S-1单药治疗与S-1联合治疗吉西他滨(GEM)难治性晚期胰腺癌(PC)的疗效及安全性。方法计算机检索PubMed数据库、Embase数据库、Cochrane图书馆和WebofScience,检索时间为1996年1月至2017年12月,筛选符合纳入标准的随机对照试验,提取资料,使用Cochrane手册评估研究的质量,采用RevMan5.2软件进行Meta分析。结果纳入4项随机对照试验,共556例GEM难治性PC患者,其中248例接受S-1单药治疗,308例接受S-1联合治疗。Meta分析结果显示,S-1联合治疗组患者的治疗有效率明显高于S-1单药治疗组[风险比(RR)=1.75,95%CI:1.19~2.57,P﹤0.01],无进展生存期(PFS)明显长于S-1单药治疗组[风险比(HR)=0.75,95%CI:0.62~0.91,P﹤0.01];S-1联合治疗组与S-1单药治疗组患者的总生存期(OS)及嗜中性粒细胞减少症、腹泻、恶心的发生率比较,差异均无统计学意义(P﹥0.05)。亚组分析结果显示,S-1联合亚叶酸钙治疗组患者的PFS长于S-1联合奥沙利铂或伊立替康治疗组(HR=0.68,95%CI:0.50~0.93,P﹤0.05);S-1联合伊立替康治疗组患者的治疗有效率高于S-1单药治疗组(RR=3.07,95%CI:1.03~9.13,P﹤0.05)。结论与接受S-1单药治疗的患者比较,接受S-1联合治疗的患者有效率更高、PFS更长。亚组分析提示,S-1联合亚叶酸钙或伊立替康治疗方案有更好的应用前景,可考虑用于选择S-1作为二线治疗的GEM难治性晚期PC患者的治疗。Objective To evaluate the therapeutic efficacy and safety of S-1 monotherapy and S-1 combined with gemcitabine (GEM) in the treatment of refractory advanced pancreatic cancer (PC).Method Databases including Pubmed,Embase,Cochrane Libraries and Web of Science were retrieved for eligible randomized controlled clinical trials conducted during January 1996 to December 2017.Data were extracted from eligible studies,of which the quality was assessed following Cochrane manuals.Rev Man 5.2 software was used for Meta-analysis.Result Four randomized controlled trials comprising 556 patients with GEM refractory PC were included in the analysis,among which 248 patients underwent S-1 monotherapy and 308 patients underwent combined therapy of S-1.Results of Meta analysis showed a significantly higher effective rate [risk ratio (RR)=1.75,95%CI: 1.19- 2.57,P<0.01] and longer progression free survival (PFS)[hazard ratio (HR)=0.75,95%CI: 0.62-0.91,P<0.01] in the combined therapy group than in the S-1 monotherapy group;there was no statistically significant difference in overall survival (OS) or incidence of neutropenia,diarrhea,and nausea between S-1 combined treatment group and S-1 monotherapy group (P>0.05).Subgroup analysis indicated that S-1 combined treatment group had achieved much longer PFS as compared to S-1 + oxaliplatin or irinotecan group (HR= 0.68,95%CI: 0.50-0.93,P<0.05);besides,the effective rate of S-1 + irinotecan group was higher than that of S-1 monotherapy group (RR=3.07,95%CI: 1.03-9.13,P<0.05).Conclusion Compared with patients treated with S-1 monotherapy, patients treated with S-1 combined treatment had higher effective rate and longer PFS.Subgroup analysis suggests that the combination of S-1 with leucovorin or irinotecan are more promising approaches,which are preferred for patients with refractory advanced pancreatic cancer who have chosen S-1 as a second-line treatment.

关 键 词：胰腺癌 化疗 META分析 吉西他滨 S-1 

分 类 号：R735.9[医药卫生—肿瘤]