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目的:评价胃癌根治术后接受不同药物、剂量(经静脉)化疗的疗效和安全性。方法:应用国际Cochrane协作网的系统评价方法,研究文献中关于胃癌根治术后接受不同药物、剂量(经静脉)化疗组与单纯根治手术组疗效比较的随机和半随机试验进行了系统评价。结果:17个试验包括2915例病人,经异质性检验,χ2=37.58,P=0.0017,17个试验存在异质性;采用随机效应模型(D鄄L)法进行meta分析,合并效应量OR=0.66,95%可信区间为0.51～0.85,经u检验,P=0.002,说明胃癌根治术后接受不同药物、剂量(经静脉)化疗组的疗效优于单纯根治手术组。17篇文章中有9篇对化疗药物的毒性反应按WHO分度标准进行描述,副作用主要有胃肠道症状、骨髓抑制、心脏毒性、血液毒性等,5例病人死于化疗相关毒性事件。结论:胃癌根治术后接受化疗可能有一定效果,毒性事件发生率较低;在接受根治性切除术后,全身静脉化疗对提高胃癌病人的5年生存率可能有一定的作用。
Objective: To evaluate the efficacy and safety of different drugs and dosages (transvenous) chemotherapy after radical operation of gastric cancer. Methods: The systematic reviews were conducted using the systematic reviews of the Cochrane Collaboration, a systematic review of randomized and quasi-randomized trials in the literature comparing the efficacy of different drugs, dosages (intravenous) chemotherapy and radical surgery in patients with gastric cancer after radical surgery. Results: 17 trials including 2915 patients, heterogeneity test, χ2 = 37.58, P = 0.0017, 17 trials heterogeneity; random effects model (D-L) meta-analysis, the combined effect of OR = 0.66, 95% confidence interval was 0.51 ~ 0.85, u test, P = 0.002, indicating that after radical gastrectomy for different drugs, the dose (intravenous) chemotherapy group is better than the radical operation group. Nineteen of the 17 articles described toxicological responses to chemotherapeutic drugs according to WHO criteria for classification. The side effects were mainly gastrointestinal symptoms, myelosuppression, cardiotoxicity, hematological toxicity, and five patients died of chemotherapy-related toxicities. Conclusion: Chemotherapy after radical operation of gastric cancer may have a certain effect, and the incidence of toxic events is low. After radical resection, systemic vein chemotherapy may play a role in improving 5-year survival rate of patients with gastric cancer.