| OBJECTIVE:Gemcitabine is a pyrimidine antimetabolite with demonstrate activity against primary liver cancer,exhibiting cell phase specificity. Here we conduct a meta-analysis to evaluate the efficacy and safety of chemotherapy based on gemcitabine for treatment of primary liver cancer.METHODS:Qualified studies published in English and Chinese retrieving from databases such as PubMed, Embase,Springer Link,Ebsco,Google scholar,CBM,VIP,Wanfang and CNKI Database until February 31st,2015 were selected for meta-analysis.According to the inclusion and exclusion criteria,two reviewers independently screened literature,extracted data and assessed the quality of the included studies with the tool of quality assessment of quality index.Then meta-analysis was conducted using Comprehensive Meta-Analysis,version 2.RESULTS:A total of 13 studies involving 456 patients were included,which were divided into three subgroups according to the chemotherapy regimen,different dose of gemcitabine and different dosage regimen of gemcitabine. Meta analysis result suggested that the pool response rate 19.6%(95%CI:11.9%-30.4%), the pool disease control rate 56.2%(95% CI:43.8% -67.9%). The pool hematological grade III/IV consisted of anemia 8.9%(95% CI:3.7%-20%), neutropenia 31.1% (95%CI:18.3%-47.6%) and thrombocytopenia 19.1%(95%CI.-13.2%-26.8%)(1)Subgroup meta-analysis of chemotherapy regimens:Meta analysis result suggested that in GEM subgroup the response rate 5.2%, disease control rate43.3%. The hematological grade III/IV consisted of anemia 7.4%, neutropenia 22.4% and thrombocytopenia 17.2%; in gemcitabine plus cisplatin (GP) subgroup the response rate 16.4%, disease control rate 43.6%. The hematological grade Ⅲ/Ⅵ consisted of anemia 21.8%, thrombocytopenia 20.8%; in gemcitabine plus oxaplatine(GEMOX) subgroup,the response rate 28.2%, disease control rate72.7%. The hematological grade Ⅲ/Ⅵ consisted of anemia 5.8%, neutropenia 21.1% and thrombocytopenia 26.1%. GEMOX regimen might have better effects, but increase the risk of thrombocytopenia.(2) Subgroup meta-analysis of different dose of gemcitabine:The results of meta analysis showed that in the low-dose group (lg/m2), the response rate 22.6%, disease control rate 58.3%. The hematological grade III/IV consisted of anemia 10.2%, neutropenia 28.3% and thrombocytopenia 19.2%; the high-dose group(1.25g/m2), the response rate 20.1%, disease control rate 49.8%, the hematological grade Ⅲ/Ⅵ consisted of anemia 11.4%, thrombocytopenia 19%.The low-dose group (lg/m) was superior to the high-dose group(1.25g/m2) in prolonging disease control rate,whreas both response rate was the similar. The incidence of neutropenia was more serious in the low-dose group.(3) Subgroup meta-analysis of dosage regimen of gemcitabine:The results of meta-analysis showed that, in the two weekly group, the response rate 19%, disease control rate 67.3%,the hematological grade Ⅲ/Ⅵ consisted of anemia 5.6%, neutropenia 19.7% and thrombocytopenia 26%; in the three weekly group, the response rate 21.1%, disease control rate 58.6%,the hematological grade Ⅲ/Ⅵ consisted of anemia 15.1%, neutropenia 29.2% and thrombocytopenia 32.4%; in the four weekly group, the response rate 18.4%, disease control rate 45.5%,the hematological grade Ⅲ/Ⅵ consisted of anemia 7.9%, neutropenia 34.4% and thrombocytopenia10.5%.There was no difference between two weekly regimen and three weekly regimen in response rate, but disease control rate of two weekly regimen is higher than that of three weekly regimen. The incidence of thrombocytopenia was more serious in the both regimen.CONCLUSION:1、Gemcitabine is available for primary liver cancer as a effective treatment.2、Compared to GEM monotherapy,GEM-based doublets chemotherapy might have better effects.3、GEMOX treatment appears to be more active and have manageable toxicity.4、The two weekly chemotherapy regimens of GEM significantly has fewer adverse reactions, safety, worthy to be widely used in clinical practice. |
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