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目的目前吉西他滨联合放疗在治疗局部进展胰腺癌中应用最为广泛,尽管当前应用口服氟嘧啶药物卡培他滨和S-1引起关注,但无随机对照试验(RCTs)支持这项观点。方法从Medline、EMBASE、Cochrane library检索所有文献,应用综合Meta分析软件(版本2.0)收集和分析人口统计学数据、治疗反应、客观缓解率、无进展生存和总生存率及毒性反应。结果 23个队列研究中的843例患者被纳入研究,其中497例应用吉西他滨,346例口服氟嘧啶类药物。S-1联合放射治疗的患者在第1、2年的总生存率上显著高于接受吉西他滨联合放射治疗的患者[相对危险度(RR)1.27,95%可信区间(CI):1.00-1.65;P=0.03;RR 1.75,95%CI:1.18-2.60,P=0.002]。卡培他滨与吉西他滨为基础的放化疗在总生存、无进展生存和客观缓解率方面疗效具有可比性。此外,口服氟嘧啶联合放疗显著降低了血液毒性和恶心呕吐等风险。结论口服氟嘧啶结合放疗与吉西他滨结合放疗相比,有相似的疗效和较低的毒性反应,可能成为局部进展胰腺癌患者安全、可行的治疗方案。
Objective Currently, gemcitabine plus radiotherapy is most widely used in the treatment of locally advanced pancreatic cancer. Although current oral fluoropyrimidine drugs capecitabine and S-1 are of concern, no randomized controlled trials (RCTs) support this view. Methods All the literature was retrieved from Medline, EMBASE and Cochrane libraries. Demographic data were collected and analyzed using comprehensive meta-analysis software (version 2.0). The response, objective response rate, progression-free survival, overall survival and toxicity were analyzed. Results Totally 843 patients from 23 cohort studies were enrolled. Among them, 497 received gemcitabine and 346 received oral fluoropyrimidines. Patients with S-1 combination radiotherapy had significantly higher overall survival at 1 and 2 years than those treated with gemcitabine plus radiotherapy [RR] 1.27, 95% confidence interval (CI): 1.00-1.65 ; P = 0.03; RR 1.75, 95% CI: 1.18-2.60, P = 0.002]. Capecitabine and gemcitabine-based chemoradiation in the overall survival, progression-free survival and objective response rates comparable. In addition, oral fluoropyrimidine combined with radiotherapy significantly reduced the risk of hematologic toxicity and nausea and vomiting. Conclusions Oral fluoropyrimidine combined with radiotherapy has similar curative effect and lower toxicity compared with gemcitabine combined with radiotherapy and may be a safe and feasible treatment for patients with locally advanced pancreatic cancer.