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目的:评价进展期胃癌病人术后应用辅助化疗的疗效。方法:检索Entrez PubMed数据库、EMBASE数据库、Ovid数据库中的循证医学数据库、ISI Web of Knowledge数据库和中国生物医学文献数据库中有关胃癌术后辅助化疗疗效的随机对照临床试验文献,分析病人术后总生存率的风险比率(hazard ratio,HR)及其95%可信区间(confidence interval,CI)。结果:1998年1月至2009年12月间共检索到13篇文献(4067例病例),Jadad评分均为3分。发现手术合并化疗组相对于单独手术组病人的术后生存率的HR(95%CI)为0.79(0.72,0.86),亚组分析发现术后辅助化疗的有效性不受肿瘤淋巴结转移情况、淋巴结清扫手术类型、人种及化疗药物给药途径等因素的影响。源于日本之临床试验报道的术后生存率明显高于西方国家。结论:术后辅助化疗能使进展期胃癌病人获益。标准的D2淋巴结清扫手术联合术后口服氟尿嘧啶化疗是这类病人的最佳选择之一。
Objective: To evaluate the efficacy of postoperative adjuvant chemotherapy in patients with advanced gastric cancer. Methods: Randomized controlled clinical trials on the efficacy of postoperative adjuvant chemotherapy for gastric cancer in Entrez PubMed database, EMBASE database, evidence-based medicine database in Ovid database, ISI Web of Knowledge database and Chinese Biomedical Literature Database were searched. The hazard ratio (HR) of survival and its 95% confidence interval (CI). Results: A total of 13 articles (4067 cases) were retrieved from January 1998 to December 2009 and the Jadad score was 3 points. It was found that the HR (95% CI) of postoperative survival in patients with surgery combined with chemotherapy alone was 0.79 (0.72, 0.86). Subgroup analysis found that the effectiveness of postoperative adjuvant chemotherapy was not affected by tumor lymph node metastasis, lymph node The type of surgical procedure, the race and the route of administration of chemotherapeutic drugs. Postoperative survival rates reported from clinical trials in Japan were significantly higher than those in Western countries. Conclusions: Postoperative adjuvant chemotherapy can benefit patients with advanced gastric cancer. Standard D2 lymph node dissection combined with postoperative oral fluorouracil chemotherapy is one of the best options for this type of patient.