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目的评价卡培他滨+伊立替康与氟尿嘧啶/醛氢叶酸(5-FU/LV)+伊立替康治疗转移性结直肠癌的有效性和安全性。方法计算机检索PubMed、CENTRAL、Embase、中国生物医学数据库、中国期刊全文数据库、维普数据库和万方数据库,检索时间均从建库至2011年9月。对符合纳入标准的随机对照试验进行质量评价和Meta分析。结果纳入3个随机对照试验,共计419例患者,卡培他滨+伊立替康在中位生存期、完全缓解率[RR=1.58,95%CI(0.27,9.11),P=0.61]、部分缓解率[RR=0.86,95%CI(0.68,1.09),P=0.20]、总有效率[RR=0.88,95%CI(0.71,1.09),P=0.26]上表现出与5-FU/LV+伊立替康相似的效果,安全性方面卡培他滨+伊立替康有较高的Ⅲ/Ⅳ级恶心[RR=1.92,95%CI(1.05,3.54),P=0.04]、腹泻[RR=3.23,95%CI(2.14,4.89),P<0.000 01]发生风险和较低的Ⅲ/Ⅳ级中性粒细胞减少[RR=0.72,95%CI(0.53,0.98),P=0.04]发生风险。结论根据当前现有证据,5-FU/LV+伊立替康可能较卡培他滨+伊立替康更为有利于转移性结直肠癌患者的治疗,但仍需结合临床实际情况进行化疗方案的优选。
Objective To evaluate the efficacy and safety of capecitabine + irinotecan with 5-fluorouracil / irinotecan in the treatment of metastatic colorectal cancer. Methods PubMed, CENTRAL, Embase, Chinese Biomedical Database, Chinese Journal Full-text Database, VIP Database and Wanfang Database were searched by computer. The retrieval time was from database construction to September 2011. Quality control and meta-analysis were performed on randomized controlled trials that met the inclusion criteria. Results A total of 419 patients were enrolled in 3 randomized controlled trials. The median survival and complete response rate of capecitabine + irinotecan were as follows: RR = 1.58, 95% CI (0.27, 9.11), P = 0.61; The overall response rate (RR = 0.88, 95% CI (0.71, 1.09), P = 0.26] was significantly higher than that of 5-FU / LV + irinotecan, capecitabine + irinotecan had a higher grade III / IV nausea [RR = 1.92, 95% CI (1.05, 3.54), P = 0.04], diarrhea [RR = 3.23, 95% CI 2.14, 4.89, P <0.000 01] and lower grade III / IV neutropenia [RR = 0.72,95% CI (0.53,0.98, P = 0.04] Risk. Conclusion According to the current available evidence, 5-FU / LV + irinotecan may be more beneficial than capecitabine + irinotecan in the treatment of patients with metastatic colorectal cancer, but the combination of clinical conditions and the need for the optimal chemotherapy .