Paoletti X,et al最近一項薈萃分析顯示，與僅接受手術的患者相比，那些在胃癌術後跟着接受化療的患者與其死亡風險的下降以及無病生存率的提高有關。研究論文5月5日發表於《美國醫學會雜誌》 （JAMA）（原文Abstract見文後）。
胃癌是一種常見而且高度致命的疾病，其目前的5年生存率低於20%。法國國立癌症研究所的 Paoletti以及其在全球晚期胃癌國際協作研究組 (GASTRIC) 通過一項基於來自所有相關試驗的個體患者的數據薈萃分析，對輔助性化療的益處進行了定量評估。在這項分析中，研究人員找到了31個符合條件的試驗（含6390例患者）。到2010年的時候，人們可獲得來自17項試驗的個體患者的數據（有3838例患者，相當於目標數據的60%）其隨訪的中位數（中點）超過7年。
研究者寫道：“總之，這一患者層面上的薈萃分析顯示，輔助性的以氟尿嘧啶爲基礎的化療，甚至那些使用單個藥物的化療，都與總體生存率的改善有關，因此建議那些在其胃癌全切除之後沒有接受手術前後治療的患者使用輔助性化療。基於所收集數據的未來的報告將探索預後因子以及以無病生存替代這一羣體的總體生存的做法。”
相關鏈接: JAMA. 2010;303(17):1729-1737
Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis.
JAMA. 2010 May 5;303(17):1729-37
Authors: , Paoletti X, Oba K, Burzykowski T, Michiels S, Ohashi Y, Pignon JP, Rougier P, Sakamoto J, Sargent D, Sasako M, Van Cutsem E, Buyse M
CONTEXT: Despite potentially curative resection of stomach cancer, 50% to 90% of patients die of disease relapse. Numerous randomized clinical trials (RCTs) have compared surgery alone with adjuvant chemotherapy, but definitive evidence is lacking. OBJECTIVES: To perform an individual patient-level meta-analysis of all RCTs to quantify the potential benefit of chemotherapy after complete resection over surgery alone in terms of overall survival and disease-free survival, and to further study the role of regimens, including monochemotherapy; combined chemotherapy with fluorouracil derivatives, mitomycin C, and other therapies but no anthracyclines; combined chemotherapy with fluorouracil derivatives, mitomycin C, and anthracyclines; and other treatments. DATA SOURCES: Data from all RCTs comparing adjuvant chemotherapy with surgery alone in patients with resectable gastric cancer. We searched MEDLINE (up to 2009), the Cochrane Central Register of Controlled Trials, the National Institutes of Health trial registry, and published proceedings from major oncologic and gastrointestinal cancer meetings. STUDY SELECTION: All RCTs closed to patient recruitment before 2004 were eligible. Trials testing radiotherapy; neoadjuvant, perioperative, or intraperitoneal chemotherapy; or immunotherapy were excluded. Thirty-one eligible trials (6390 patients) were identified. DATA EXTRACTION: As of 2010, individual patient data were available from 17 trials (3838 patients representing 60% of the targeted data) with a median follow-up exceeding 7 years. RESULTS: There were 1000 deaths among 1924 patients assigned to chemotherapy groups and 1067 deaths among 1857 patients assigned to surgery-only groups. Adjuvant chemotherapy was associated with a statistically significant benefit in terms of overall survival (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.76-0.90; P < .001) and disease-free survival (HR, 0.82; 95% CI, 0.75-0.90; P < .001). There was no significant heterogeneity for overall survival across RCTs (P = .52) or the 4 regimen groups (P = .13). Five-year overall survival increased from 49.6% to 55.3% with chemotherapy. CONCLUSION: Among the RCTs included, postoperative adjuvant chemotherapy based on fluorouracil regimens was associated with reduced risk of death in gastric cancer compared with surgery alone.
PMID: 20442389 [PubMed - in process]