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目的:吉西他滨单药作为一线治疗晚期胰腺癌已成为标准治疗方案,本研究通过me-ta分析吉西他滨为主的联合化学治疗晚期胰腺癌的生存结果,以寻找确切有效的联合化疗方案。方法:通过MEDLINE、EMBASE、ASCO、ECCO等数据库及论文集检索相关文献。主要对各亚组半年生存率、1年生存率和客观缓解率进行meta分析。结果:16个随机对照临床试验(RCT)共2058例患者纳入分析,按化疗方案分为吉西他滨联合铂类、吉西他滨联合氟尿嘧啶类、吉西他滨联合伊利替康等3个亚组,各亚组半生存率的治疗优势(RD)分别为3%(P=0.003)、8%(P=0.003)、-1%(P=0.88):1年生存率RD为4%(P=0.06)、1%(P=0.10)、1%(P=0.89);客观缓解率RD为2%(P=0.32)、8%(P=0.01)、10%(P=0.0003)。结论:现有的证据提示吉西他滨联合氟尿嘧啶类药物一线治疗晚期胰腺癌,有较好的应用前景,值得进一步的临床试验。在选择联合化疗时对体质状态的要求较高,带瘤生存可能是治疗晚期胰腺癌应达到的最佳疗效。
Objective: Gemcitabine monotherapy as a first-line treatment of advanced pancreatic cancer has become the standard treatment of this study by me-ta analysis of gemcitabine-based chemotherapy combined with the survival of advanced pancreatic cancer in order to find the exact combination of chemotherapy. Methods: The relevant literature was searched through MEDLINE, EMBASE, ASCO, ECCO and other databases and essays. The six-year survival rate, one-year survival rate and objective response rate of each subgroup were mainly analyzed by meta-analysis. Results: A total of 2058 RCT patients were included in the analysis. According to the chemotherapy regimen, they were divided into three subgroups: gemcitabine combined with platinum, gemcitabine combined with fluorouracil, gemcitabine combined with irinotecan. The semi-survival rates (RD) were 3% (P = 0.003), 8% (P = 0.003) and -1% (P = 0.88) respectively. The 1-year survival rate was 4% P = 0.10), 1% (P = 0.89). The objective response rates were 2% (P = 0.32), 8% (P = 0.01) and 10% (P = 0.0003) respectively. Conclusion: The available evidence suggests that gemcitabine combined with fluorouracil first-line treatment of advanced pancreatic cancer has a good prospect and deserves further clinical trials. In the choice of combination chemotherapy when the physical condition of the higher survival of the tumor may be the treatment of advanced pancreatic cancer should achieve the best effect.