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Efficacy And Safety Of Neoadjuvant Chemotherapy With Paclitaxel + Platinum + Fluorouracil In The Treatment Of Advanced Gastric Cancer:a Meta-analysis

Posted on:2024-06-29Degree:MasterType:Thesis
Country:ChinaCandidate:L ChenFull Text:PDF
GTID:2544307148474004Subject:Surgery
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Objective:Through meta-analysis,we compared the efficacy and safety of neoadjuvant chemotherapy with paclitaxel + platinum + fluorouracil(three-drug regimen)and platinum+ fluorouracil(two-drug regimen)in the treatment of advanced gastric cancer(AGC),including Objective response rate(ORR),disease control rate(DCR),R0 removal rate,postoperative complication rate,Grade 3-4 adverse events(AEs)after chemotherapy,overall survival(OS),and progression-free survival(PFS),in order to provide evidence-based medical support for clinical treatment decisions.Methods:1.We searched Pub Med,Embase,Cocharane Library,Web of Science,China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP Database and China Biology Medicine(CBM)up to February 2023 for publications reporting neoadjuvant chemotherapy with paclitaxel + platinum + fluorouracil in the treatment of AGC.2.We used Endnote X9 software to manage the literatures.After removing duplicate literatures,the titles and abstracts were read for preliminary screening.The full text of the remaining literatures were read for secondary screening.Finally,the randomized controlled trials meeting the requirements were included.3.We used pre-designed tables for data extraction.4.Cochrane bias risk assessment tool was used to evaluate the quality of the included literatures.5.Rev Man 5.4 software was used for meta-analysis.The sensitivity analysis was carried out by eliminating literatures one by one.Egger’s test was used to judge publication bias by the Stata 11.Results:1.Basic information of the included literatures: The 9 literatures included were all randomized controlled trials,including 5 Chinese literatures and 4 English literatures.A total of 725 patients were included,including 365 patients in the three-drug regimen group and360 patients in the two-drug regimen group.2.Efficacy analysis: ORR in the three-drug regimen group was higher than that in the two-drug regimen group(RR=1.50,95% CI: 1.27-1.78,P<0.001);There was no statistical difference in DCR between the two groups(RR=1.08,95%CI: 1.00-1.18,P=0.05).There was no statistical difference in R0 removal rate between the two groups(RR=1.11,95%CI:0.99-1.24,P=0.08).In the 2 course of neoadjuvant chemotherapy subgroup(RR=1.03,95%CI: 0.87-1.23,P=0.70),there was no statistical difference in R0 removal rate between the three-drug regimen group and the two-drug regimen group.In the 4 course of neoadjuvant chemotherapy subgroup(RR=1.03,95%CI: 0.97-1.10,P=0.28),there was no statistical difference in R0 removal rate between the three-drug regimen group and the twodrug regimen group.PFS(HR=0.58,95%CI: 0.41-0.83,P=0.003)was longer in the threedrug regimen than that in the two-drug regimen,and there was no statistical difference in OS between the two groups(HR=0.81,95%CI: 0.51-1.30,P=0.39).3.Safety analysis: The incidence of grade 3-4 AEs showed that the incidence of neutropenia(RR=1.38,95%CI: 1.02-1.87,P=0.03)and thrombocytopenia(RR=2.82,95%CI:1.09-7.33,P=0.03)in the three-drug regimen group was higher than that in the two-drug regimen group.The incidence of leukopenia(RR=1.82,95%CI: 1.01-3.30,P=0.05),anemia(RR=1.44,95%CI: 0.79-2.65,P=0.23),nausea(RR=1.49,95%CI: 0.85-2.63,P=0.17),vomiting(RR=2.74,95%CI: 0.95-7.95,P=0.06),diarrhea(RR=1.72,95% CI: 0.69-4.32,P=0.25),fatigue(RR=1.42,95%CI=0.69-2.91,P=0.35)and decreased appetite(RR=1.31,95%CI: 0.72-2.39,P=0.37)were not statistically significant.The incidence of postoperative complications(RR=1.17,95%CI: 0.87-1.57,P=0.31)were not statistically significant.4.Publication bias: Since less than 10 studies were included in this study,funnel plot was not drawn for bias analysis.Egger’s test was used to evaluate whether publication bias existed in the result.Results showed no publication bias in ORR(P=0.055),DCR(P=0.390),and R0 removal rate(P=0.093).Conclusion:1.In terms of effectiveness,compared with platinum-fluorouracil neoadjuvant chemotherapy regimen,paclitaxel + platinum + fluorouracil neoadjuvant chemotherapy regimen improved ORR and prolonged PFS,but showed no advantage in DCR,R0 removal rate,and OS.2.In terms of safety,the incidence of neutropenia and thrombocytopenia was higher in three-drug regimen group.However,there was no difference in the incidence of postoperative complications between the two groups.
Keywords/Search Tags:gastric cancer, neoadjuvant chemotherapy, paclitaxel, meta-analysis
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