据5月5日刊JAMA上的一则研究披露，据一项对从前研究的分析发现，与仅接受手术的患者相比，那些在胃癌术后跟着接受化疗的患者与其死亡风险的下降以及无病存活率的提高有关。
根据文章的背景资讯，胃癌是一种常见而且高度致命的疾病，其目前的5年存活率低于20%。
Institut National du Cancer, Boulogne, France的Xavier Paoletti, Ph.D.以及其在Global Advanced/Adjuvant Stomach Tumor Research International Collaboration (GASTRIC) Group的同僚通过一则基于来自所有相关试验的个体患者的数据荟萃分析，对辅助性化疗的裨益进行了定量评估。在这一分析中，研究人员找到了31个符合条件的试验（含6390位患者）。到2010年的时候，人们可获得来自17个试验的个体患者的数据（有3838名患者，相当于目标数据的60%）其随访的中位数（中点）超过7年。
文章的作者写道：“总之，这一患者层面上的荟萃分析显示，辅助性的以氟脲嘧啶为基础的化疗，甚至那些使用单个药物的化疗，都与总体存活率的改善有关，因此建议那些在其胃癌全切除之后没有接受手术前后治疗的患者使用辅助性化疗。基于所收集数据的未来的报告将探索预后因子以及以无病存活替代这一群体的总体存活的做法。”
推荐原文出处：
JAMA. 2010;303(17):1729-1737.
Benefit of Adjuvant Chemotherapy for Resectable Gastric Cancer
A Meta-analysis
The GASTRIC (Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group*
Context Despite potentially curative resection of stomach cancer, 50% to 90% of patients die of disease relapse. Numerous randomized clinical trials (RCTs) have compared surgery alone with adjuvant chemotherapy, but definitive evidence is lacking.
Objectives To perform an individual patient-level meta-analysis of all RCTs to quantify the potential benefit of chemotherapy after complete resection over surgery alone in terms of overall survival and disease-free survival, and to further study the role of regimens, including monochemotherapy; combined chemotherapy with fluorouracil derivatives, mitomycin C, and other therapies but no anthracyclines; combined chemotherapy with fluorouracil derivatives, mitomycin C, and anthracyclines; and other treatments.
Data Sources Data from all RCTs comparing adjuvant chemotherapy with surgery alone in patients with resectable gastric cancer. We searched MEDLINE (up to 2009), the Cochrane Central Register of Controlled Trials, the National Institutes of Health trial registry, and published proceedings from major oncologic and gastrointestinal cancer meetings.
Study Selection All RCTs closed to patient recruitment before 2004 were eligible. Trials testing radiotherapy; neoadjuvant, perioperative, or intraperitoneal chemotherapy; or immunotherapy were excluded. Thirty-one eligible trials (6390 patients) were identified.
Data Extraction As of 2010, individual patient data were available from 17 trials (3838 patients representing 60% of the targeted data) with a median follow-up exceeding 7 years.
Results There were 1000 deaths among 1924 patients assigned to chemotherapy groups and 1067 deaths among 1857 patients assigned to surgery-only groups. Adjuvant chemotherapy was associated with a statistically significant benefit in terms of overall survival (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.76-0.90; P & .001) and disease-free survival (HR, 0.82; 95% CI, 0.75-0.90; P & .001). There was no significant heterogeneity for overall survival across RCTs (P = .52) or the 4 regimen groups (P = .13). Five-year overall survival increased from 49.6% to 55.3% with chemotherapy.
Conclusion Among the RCTs included, postoperative adjuvant chemotherapy based on fluorouracil regimens was associated with reduced risk of death in gastric cancer compared with surgery alone.
