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[目的]评价新辅助化疗(neoadjuvant chemotherapy,NAC)在进展期胃癌中的安全性和有效性。[方法]在Pubmed、Cochrane library和EMbase等数据库中检索1990年1月至2015年9月发表的有关NAC的随机对照试验(randomized controlled trials,RCTs),由两位独立的研究人员进行文献筛选和数据提取。采用Rev Man 5.3软件进行荟萃分析。[结果]共纳入16项RCTs,共2077例患者(NAC组308例,对照组316例)。结果显示NAC较对照组能提高进展期胃癌的总体生存率(HR=0.74,95%CI:0.63~0.88,P=0.0006)、5年生存率(OR=1.61,95%CI:1.24~2.09,P=0.0004)和3年无病生存期(HR=0.66,95%CI:0.56~0.77,P<0.00001),能降低肿瘤术前分期(OR=1.71,95%CI:1.26~2.33,P=0.0006),NAC组的R0手术切除率显著性高于对照组(OR=1.55,95%CI:1.22~1.97,P=0.0003);而两组的术后并发症(OR=1.12,95%CI:0.87~1.44,P=0.40)、围术期死亡率(OR=1.14,95%CI:0.64~2.05,P=0.65)、3/4级化疗副反应发生率(P>0.05)差异无统计学意义。[结论 ]NAC能提高进展期胃癌患者的生存率,提高手术切除率,降低肿瘤分期。其安全可行,患者可耐受。
[Objective] To evaluate the safety and efficacy of neoadjuvant chemotherapy (NAC) in advanced gastric cancer. [Methods] Randomized controlled trials (RCTs) on NAC published from January 1990 to September 2015 were retrieved from databases such as Pubmed, Cochrane Library and EMbase. Two independent researchers screened the literature and Data Extraction. A meta-analysis using Rev Man 5.3 software. [Results] A total of 16 RCTs were enrolled, with a total of 2077 patients (308 in the NAC group and 316 in the control group). The results showed that compared with the control group, NAC can improve the overall survival rate of advanced gastric cancer (HR = 0.74,95% CI: 0.63-0.88, P = 0.0006) and 5 year survival rate (OR = 1.61,95% CI: 1.24-2.09, (OR = 1.71, 95% CI: 1.26-2.33, P = 0.0004) and 3 year disease free survival (HR = 0.66,95% CI: 0.56-0.77, P <0.00001) (OR = 1.55, 95% CI: 1.22-1.97, P = 0.0003). However, postoperative complications (OR = 1.12, 95% CI, P = 0.0003) in the NAC group were significantly higher than those in the control group (OR = 1.14, 95% CI: 0.64 ~ 2.05, P = 0.65), and there was no significant difference in grade 3/4 chemotherapy (P> 0.05) between the two groups Significance of learning. [Conclusion] NAC can improve the survival rate of patients with advanced gastric cancer, improve the surgical resection rate and reduce the tumor stage. It is safe and patient tolerable.