【摘要】：目的：采用循證醫(yī)學(xué)Meta分析的方法分析胃癌術(shù)后放化療聯(lián)合與單純化療的隨機(jī)對(duì)照試驗(yàn)的結(jié)果差異,‘評(píng)價(jià)其有效性及安全性。方法：檢索相關(guān)期刊論文(CNKI)、維普數(shù)據(jù)庫(kù)(VIP)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM); Cochrane圖書(shū)館、PubMed和EMBASE(檢索截至日期為2014年6月),納入有關(guān)胃癌術(shù)后放療聯(lián)合化療及單純化療的隨機(jī)對(duì)照試驗(yàn)(RCT),并對(duì)所納入的文獻(xiàn)進(jìn)行質(zhì)量評(píng)價(jià),收集文獻(xiàn)內(nèi)數(shù)據(jù),采用RevMan5.2和Stata 12.0軟件進(jìn)行分析評(píng)價(jià)。比較兩組1、2、3年生存率；3、5年疾病無(wú)進(jìn)展生存期(PFS),5年總生存率(OS),以及治療出現(xiàn)的中重度胃腸道反應(yīng),骨髓抑制,手足綜合征等不良反應(yīng)指標(biāo)。結(jié)果：最終納入11個(gè)RCT,共包括1143例患者,均為術(shù)后放化療聯(lián)合與單純化療的隨機(jī)對(duì)照試驗(yàn)。Meta分析結(jié)果顯示：1.進(jìn)展期胃癌術(shù)后放化療聯(lián)合較之單純化療1年生存率[RR=1.20(95%CI：1.10～1.30)]、2年生存率[RR=1.34(95%CI:1.16～1.56)]、3年生存率[RR=1.57(95%CI：1.27-1.86)]、3年疾病無(wú)進(jìn)展生存率[RR=1.10(95%CI：1.00～1.21)],5年疾病無(wú)進(jìn)展生存率[RR=1.27(95%CI:1.02～1.60)]及5年總生存率[RR=1.24(95%CI：1.01～1.51)]差異均存在統(tǒng)計(jì)學(xué)意義,對(duì)胃癌D2淋巴結(jié)清掃術(shù)后進(jìn)行亞組分析,在生存期差異與整體相似；2.兩組在Ⅲ-Ⅳ度白細(xì)胞減低發(fā)生[RR=1.24(95%CI：1.02-1.50)]差異存在統(tǒng)計(jì)學(xué)意義,但在其他不良反應(yīng)中如：Ⅲ-Ⅳ血紅蛋白減低,血小板減低,胃腸道反應(yīng),手足綜合征等發(fā)生率相似,差異并沒(méi)有統(tǒng)計(jì)學(xué)意義。結(jié)論：胃癌術(shù)后放化療聯(lián)合輔助治療較之單純化療在提高胃癌患者的生存時(shí)間獲益更為明顯,且與放化療相關(guān)的不良反應(yīng)未明顯增加,患者耐受依存性尚可。
[Abstract]:Objective: to evaluate the efficacy and safety of radiotherapy and chemotherapy combined with chemotherapy alone in patients with gastric cancer. Methods: the (CBM); Cochrane library, PubMed and EMBASE (search date is June 2014) of the Chinese Journal Full-text Database (CNKI),) and the Chinese Biomedical Literature Database (VIP),) were searched, which included radiotherapy combined with chemotherapy and simplex chemotherapy after operation for gastric cancer. Randomized controlled trial (RCT),) was conducted to evaluate the quality of the literature involved. The data were collected and evaluated by RevMan5.2 and Stata 12.0 software. The survival rate of 1 and 3 years, the 5 year overall survival rate of (PFS), for 3 and 5 years without progression of disease, and the adverse reactions such as moderate and severe gastrointestinal reaction, bone marrow suppression, hand and foot syndrome were compared between the two groups. Results: 1143 patients were included in 11 RCT, patients. All of them were randomized controlled trials of radiotherapy and chemotherapy combined with chemotherapy alone. The results of Meta analysis showed: 1. 1 year survival rate [RR=1.20 (95%CI:1.10~1.30)], 2 year survival rate [RR=1.34 (95%CI:1.16~1.56)], 3 year survival rate [RR=1.57 (95%CI:1.27-1.86)], 3 year progression free survival rate [RR=1.10 (95%CI:1.00~1.21)], 5 years disease progression free survival rate [RR=1.27 (95%CI:1.02~1.60)] and 5 The annual overall survival rate [RR=1.24 (95%CI:1.01~1.51)] was statistically significant. The subgroup analysis of D2 lymph node dissection of gastric cancer showed that the difference of survival time was similar to that of the whole. 2. The incidence of RR=1.24 (95%CI:1.02-1.50) in grade 鈪，

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