术前动脉灌注化疗治疗局部晚期胃癌的系统评价

刘锐锋; 王小琦; 王小虎; 张春林

doi:10.3971/j.issn.1000-8578.2012.09.012

术前动脉灌注化疗治疗局部晚期胃癌的系统评价

1.730050兰州,甘肃省肿瘤医院放疗科，2.放射科

基金项目: 甘肃省科技厅科技创新团队资助项目（09877CA009）

详细信息

作者简介:
刘锐锋（1983－），男，硕士，住院医师，主要从事消化道肿瘤的放射及综合治疗研究

通讯作者:
王小琦，E-mail： liurf@yahoo.cn

中图分类号: R735.2
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出版历程
- 收稿日期: 2012-01-02
- 修回日期: 2012-03-26
- 刊出日期: 2012-09-24

Preoperative Intra-arterial Infusion Chemotherapy for Locally Advanced Gastric Cancer：A Systematic Review

1.Department of Radiotherapy,Tumor Hospital of Gansu Province，Lanzhou 730050,China，2.Department of Radiology

摘要

摘要: 目的评价术前动脉灌注化疗与全身静脉化疗或单独手术治疗局部晚期胃癌的有效性和安全性。方法计算机检索PubMed（2000年1月—2011年5月）、EMBASE（2000年1月—2011年5月），Cochrane Library（2011年第4期），中国生物医学文献数据库（CBM，2000年1月—2011年5月）、中国期刊全文数据库(CJFD,2000年1月~2011年5月）和中文科技期刊全文数据库(CSJD,2000年1月—2011年5月），同时从参考文献中追溯查找。按照纳入标准，全面搜集有关术前动脉灌注化疗（IAIC+S）与全身静脉化疗（IVC+S）或单独手术(S)治疗局部晚期胃癌方面的临床对照试验,无论是否采用随机对照研究。按照Cochrane系统评价方法，由两位研究者独立提取资料和进行质量评价，并用RevMan5.1软件进行统计分析。结果共纳入7个研究，792例患者。Meta分析结果显示，IAIC+S组与IVC+S组相比，根治性切除率差异有统计学意义，RR(95%CI)为1.70（1.41~2.05），姑息性切除率差异无统计学意义，RR(95％CI)为0.37（0.04~3.13）。在治疗应答率中，病理学应答率、临床应答率RR(95％CI)分别为1.33（0.96~1.84）和1.32（0.50~3.44）。化疗不良反应中，除胃肠反应RR(95％CI)为0.52（0.28~0.94），骨髓抑制、肝功能损害和其他不良反应方面，两组间差异均无统计学意义，RR(95％CI)分别为0.64（0.38~1.07）、0.88（0.29~2.64）、0.93（0.53~1.61）。术后并发症方面，吻合口瘘、腹腔感染和切口感染，两组间差异均无统计学意义，RR(95％CI)分别为2.46（0.49~12.34）、0.53（0.05~5.57）、2.10（0.20~22.26）。IAIC+S组与S组相比，根治性切除和姑息性切除率方面两组间差异均存在统计学意义，RR(95％CI)分别为1.30（1.16~1.45）和 0.58（0.42~0.79）。1、2、3和5年生存率间差异均有统计学意义，RR(95％CI)分别为1.11（1.03~1.20）、1.36（1.09~1.69）、1.70（1.35~2.14）和1.85（1.30~2.65）。术后并发症方面，无论吻合口瘘、腹腔感染和切口感染方面两组间差异均无统计学意义，RR(95％CI)分别为0.78（0.27~2.28）、0.65（0.16~2.65）、1.15（0.43~3.10）。结论术前动脉灌注化疗是一种有效且安全的治疗方法。在手术切除率、总生存率、化疗不良反应以及并发症指标上，都显示出动脉灌注化疗的优势。
- 动脉化疗 /
- 静脉化疗 /
- 手术治疗 /
- 胃癌
Abstract: Objective To assess the clinical efficacy and safety of preoperative intra-arterail infusion chemothrapy(IAIC+S)+surgery(S) versus Preoperative intravenous chemotherapy+S(IVC+S) or S alone for locally advanced gastric carcinoma. Methods PubMed（January,2000 to May,2011）,EM BASE(January,2000 to May,2011),Cochrane Library(Issue 4,2011),Chinese Biomedical Literature Database(January,2000 to May,2011),China Journal Full text Database(January,2000 to December,2007)， and Chinese Scientific Journals Full text Database(January,2000 to December,2007) were searched for relevant original published in any date.We also track back to the references to collect trails.Inclusion criteria were as follows:clinical controlled trails regardless of randomization were reported in English or Chinese.Two reviewers extracted data and assessed the quality of included trials independently.The RevMan 5.1 software was used for statistical analysis. Results Seven studies involving 792 patients were included.Meta-analysis showed that,between(IAIC+S) and (IVC+S),there was significant difference in radical resection rate,and the pooled RR（95%CI）was 1.70（1.41~2.05）.But in response rate,complications of postoperation and chemotherapy side effects,they all had no statistical difference.Between(IAIC+S) and S alone,RRs of radical and palliative resection rates（95％CI） were 1.30（1.16~1.45）and 0.58（0.42~0.79）respectively.All 1-year,3-year,4-year,5-year and overall survival had statistical signicance,with 1.11（1.03~1.20）,1.36（1.09~1.69）,1.70（1.35~2.14）and 1.85（1.30~2.65）,respectively.In postoperative complications,RRs （95％CI） of anastomotic leakage,abdominal infection and wound infection were 0.78（0.27~2.28），0.65（0.16~2.65） and 1.15（0.43~3.10）respectively,without statistical differences. Conclusion This study suggested that IAIC is an effective and safety method compared with IVC or S alone in improving radical resection rate and survival rate for locally advance gastric cancer.But in view of the poor quality of included studies,our result was needed to be furtherly confirmed.
- Intraarterial infusion chemotherapy /
- Intravenous chemotherapy /
- Operation /
- Gastric carcinoma

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参考文献(23)

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术前动脉灌注化疗治疗局部晚期胃癌的系统评价

作者简介:
刘锐锋（1983－），男，硕士，住院医师，主要从事消化道肿瘤的放射及综合治疗研究

通讯作者:
王小琦，E-mail： liurf@yahoo.cn

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Preoperative Intra-arterial Infusion Chemotherapy for Locally Advanced Gastric Cancer：A Systematic Review

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术前动脉灌注化疗治疗局部晚期胃癌的系统评价

作者简介: 刘锐锋（1983－），男，硕士，住院医师，主要从事消化道肿瘤的放射及综合治疗研究

通讯作者: 王小琦，E-mail： liurf@yahoo.cn

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Preoperative Intra-arterial Infusion Chemotherapy for Locally Advanced Gastric Cancer：A Systematic Review

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作者简介:
刘锐锋（1983－），男，硕士，住院医师，主要从事消化道肿瘤的放射及综合治疗研究

通讯作者:
王小琦，E-mail： liurf@yahoo.cn