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目的系统评价含替吉奥的新辅助化疗方案联合手术在进展期胃癌治疗中的有效性和安全性。方法计算机检索EMbase、PubMed、The Cochrane Library、Web of Science、CBM、CNKI和WanFang Data数据库,搜集国内外公开发表的替吉奥新辅助化疗联合手术治疗进展期胃癌的随机对照试验(RCT),检索时限均从建库至2017年2月。由2名研究者独立进行文献筛选、资料提取和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入11个RCT,包括971例进展期胃癌患者。Meta分析结果显示,与对照组比较,含替吉奥的新辅助化疗联合手术组可提高根治性手术切除率(R_0切除率)[OR=2.75,95%CI(1.91,3.95),P<0.000 01]、2年生存率[OR=1.72,95%CI(1.01,2.93),P=0.05]及3年生存率[OR=1.64,95%CI(1.12,2.41),P=0.01],而在有效率[OR=1.33,95%CI(0.70,2.51),P=0.39]、1年生存率[OR=1.50,95%CI(0.64,3.53),P=0.35]和术后并发症发生率[OR=1.00,95%CI(0.66,1.51),P=0.98]方面,二者差异无统计学意义。结论含替吉奥新辅助化疗联合手术治疗可提高进展期胃癌R_0切除率、2年生存率和3年生存率,且不增加术后并发症发生率。受纳入研究数量和质量的限制,上述结论尚待开展更多高质量研究予以验证。
Objective To systematically evaluate the efficacy and safety of neoadjuvant chemotherapy regimens containing tioguanide in the treatment of advanced gastric cancer. Methods The databases of EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI and WanFang Data were searched by computer. The randomized controlled trials (RCTs) published by domestic and international public for the combined treatment of neoadjuvant chemotherapy and advanced gastric cancer were searched Time limit from the building to February 2017. Two researchers independently conducted literature review, data extraction, and evaluation of the risk of bias included in the study. Meta-analysis was performed using RevMan 5.3 software. Results A total of 11 RCTs were included, including 971 patients with advanced gastric cancer. Meta-analysis showed that, compared with the control group, neoadjuvant chemotherapy combined with tigiao group improved the rate of radical resection (R0 resection rate) [OR = 2.75,95% CI (1.91, 3.95), P <0.000 (OR = 1.72, 95% CI (1.01, 2.93), P = 0.05] and 3-year survival rate [OR = 1.64, 95% CI 1.12, 2.41, P = 0.01] The 1 year survival rate [OR = 1.50, 95% CI (0.64, 3.53), P = 0.35] and postoperative complications occurred in patients with effective rate [OR = 1.33,95% CI 0.70,2.51, P = 0.39] Rate [OR = 1.00, 95% CI (0.66, 1.51), P = 0.98], the difference was not statistically significant. CONCLUSION: The combination of neoadjuvant chemotherapy with TEGO can improve the R 0 resection rate, 2-year survival rate and 3-year survival rate of advanced gastric cancer without increasing the incidence of postoperative complications. Due to the limitations of the quantity and quality of the research, the above conclusions have yet to be verified by more high-quality studies.