切除胃癌的外科手术与辅助化疗:随机对照试验的元分析
Haiya Ou1, Jiamei Zhuang2, Mingwei Jian1
1Department of Gastroenterology, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China.
Frontiers in oncology
|March 21, 2025
概括
与辅助化疗 (AC) 相比,新辅助化疗 (NAC) 在可切除胃癌中显著改善无进展生存率 (PFS). 在女性和结节阳性患者中,NAC显示出更大的益处,趋势是改善整体存活率 (OS).
科学领域:
- 在瘤学瘤学.
- 胃肠病学 胃肠病学
- 临床试验 临床试验
背景情况:
- 胃癌仍然是一个重大的全球健康挑战.
- 优化化疗时间 (术后与辅助) 对于切除性疾病至关重要.
- 随机对照试验 (RCT) 的证据需要综合以指导临床实践.
研究的目的:
- 对可切除的胃癌进行一次系统性审查和RCT的元分析,比较术前 (新辅助) 化疗 (NAC) 与辅助化疗 (AC).
- 评估NAC与AC对整体生存 (OS) 和无进展生存 (PFS) 的影响.
主要方法:
- 在PubMed,Embase,Web of Science和Cochrane数据库进行系统的文献搜索,截至2024年4月.
- 包括5个RCT,包括2,735名患者.
- 对OS和PFS的元分析,根据患者特征进行子组分析.
主要成果:
- 与AC相比,NAC显著改善了PFS (HR:0.77;95%CI:0.69,0.85;P<0.00001).与AC相比,NAC显著改善了PFS (HR:0.77;95%CI:0.69,0.85;P<0.00001).与AC相比,NAC显著改善了PFS.
- 亚组分析显示女性 (HR:0.53;P<0.0001) 和cN+ (HR:0.77;P=0.0005) 患者的NAC优势.
- 通过NAC观察到改善OS的趋势 (HR:0.86;P=0.17),尽管灵敏度分析表明不稳定.
结论:
- 新辅助化疗为可切除胃癌患者提供了比辅助化疗更大的PFS益处.
- 在女性和节点阳性 (cN+) 患者小组中,NAC的益处更为明显.
- NAC显示了改善整体存活率的潜力,需要进一步调查.
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