2009 9 3 The Journal of EvidenceBased Medicine Jun. 2009 Vol.9 No.3 a b c d d a a ( a. ; b. ; c. ; d. 510282) [ ] Cochrane Cochrane MEDLINE EMBASE OVID CBM CNKI EBSCO 2008 3 2 RevMan 4.2.8 8 482 GP ( + )FP ( + )1 3 GP [ 1.13 95% (1.021.25) P=0.02];GP ( + )GEM( ) [ 1.81 95% (1.03.08) P=0.03]1 [ 1.78 95% (1.033.0) P=0.04]3 ;GEM + CBP ( )DOC + DDP ( ) P<0.01; (P=0.013) 1 (P=0.018) (P=0.013) [ ] ; ; ; [ ] R739.3 [ ] A [ ] 1715144(2009)0301107 A Systematic Review of Gemcitabine for the Treatment of Advanced Nasopharyngeal Carcinoma ZHONG Jinghua a LIU Ruilin b CHEN Jing c ZHANG Jiren d HU Xigang d WANG Liqing a WANG Yong a (a. Department of Pharmacy; b. Administrative Department; c. Department of Information; d. Department of Oncology Zhujiang Hospital Southern Medical University Guangzhou 510282 China) Abstract: Objective To evaluate the role of Gemcitabine in the treatment of advanced nasopharyngeal carcinoma (NPC).Methods Up to 2008 we searched the Cochrane Library MEDLINE EMBASE OVID CBM CNKI and EBSCO. The quality of included studies was evaluated and analyses were performed for the results of homogeneous studies by RevMan 4.2.8 software. Results 8 studies involving 482 participants with NPC were included. Analyses showed that 1 and 3 year survival rate of GP (Gemcitabine + Cisplatin) regimen had no significant difference compared with FP regimen (Fluorouracil + Cisplatin) but had higher remission rate [RR=1.13 95%CI(1.021.25) P=0.02]; The response rate and 1 year survival rate of GP (Gemcitabine + Cisplatin) regimen was higher than that of monotherapy with Gemcitabine [RR=1.81 95%CI(1.03.08) P=0.03] [RR=1.78 95%CI(1.033.0) P=0.04] but it had no significant difference between the two regimens in 3 year survival rate; the remission rate of GEM + CBP (Gemcitabine + Carboplatin) regimen was significant higher compared with DOC + DDP regimen (Paclitaxel + Cisplatin) (P<0.01). Compared with different mode of administration there is higher response rate (P=0.013) 1 year survival rate (P=0.018) and longer median survival time(p=0.013) when Gemcitabine was administered by artery than venous. Conclusions Gemcitabine is an effective agent for NPC whatever used as monotherapy or combined treatment. Key words: nasopharyngeal neoplasms; Gemcitabine; chemotherapy; systematic review [ ] (2008B030301157); (07005203); (30471928) [ ] (1981) [ ] Tel:020143555;Email:yongwh2005@13.com Tel: 020143011;Email: lrl@fimmu.com
12 2009 9 3 90% 1.1 75% 1.1.1 ~ (1) : 50% ; (2) : ( (nasopharyngeal carcinomanpc) ( / ) ) + (3) : [1] ( ) A vs. A; vs. ; + A vs. B; (4) : 1 3 ( (WHO 0~ ) ) DNA 1.1.2 [2] ;3 ( (dfdcmp) (dfdcdp) );4 (dfdctp)dfdctp 1.1.3 DNA DNA (completed responsecr) (partial remissionpr) (stable diseasesd) (PD) (CR) [3] FDA (progressive diseasepr) 1 3 WHO ~ 1.2 1.2.1 2008 3 3 ) EMBASE (1994 2008 3 ) (1994 2008 3 ) (1994 2008 3 ) Cochrane EBSCO 1 1 2 ;2 (WHO) : MEDLINE (1994 2008 OVID
: nasopharyngeal carcinoma nasopharyngeal cancer :1 nasopharyngeal neoplasm NPC NPCa gemcitabine ;2 gemzar : ( ) 2000 2008 3 ;3 1. 1.2.2 1.3 2 Cochrane RevMan4.2.8 2 1..1 χ 2 3 1.4 Juni [4] Cochrane 4.2.2 : 1..2 1 : : 95% (comfidence ; : intervalci) 95%CI 1 P > ; 0.05 ;95%CI 1 : ( 1 1) P<0.05 2 : 1..3 ; : ; : ( ; : ) [ 3 : (odds ratioor) (relative riskrr)] ;4 : 10% (intention to treatitt) 1..4 A B C : A : 4. 13 α=0.1;i 2 I 2 <25% 25%< I 2 <50% I 2 >50% (random effects model) ;B : 1 1 (fixed effects model) (OR) ; ; C : 1 1 (weighted mean differencewmd) 95%CI 1.5 (RR) 1 2 0.05 RR>1 1 1 1
14 2009 9 3 2 2.1 [13] [12] 79 1 5 3 [101213] (1) 10 RCT [5] 2 8 [714] 8 RCT [71114] 1 1 Jadad KPS (%) 1 3 B 2004 GEM 1 000 mg / m 2 d1 d8 d15+cddp mg / m 2 d1 # +RT 5FU 1 000 mg / m 2 d1~d5+cddp mg / m 2 d1 # +RT 4 4 50 50 53 53 3 4 75(3 / 4).(4 / ) 50.0(2 / 4) 33.3(2 / ) [8] 2005 C GEM 1 000 mg / m 2 d1 d8+cddp 70 mg / m 2 d2 * 12 5FU 2 500 mg / m 2 +CDDP 70 mg / m 2 d2 * 12 12 12 70 75 83 54 52 9 (12 / 12) (12 / 12) 91.(11 / 12) 33.3(4 / 12) [9] 200 B GEM 200 mg / m 2 d1 d7+cddp mg / m 2 d1 # +RT 5FU 500 mg / m 2 d1~d5+cddp 25 mg / m 2 d1~d5 # +RT 93 94 93 94 55 48.2 48.2 85 9.7(90 / 93) 94.(89 / 94) 75.2(70 / 93) 70.2( / 94) Yau TK [10] 200 C GEM 1 250 mg / m2 d1 d8+cddp mg / m 2 d1 * 34 5FU 1 000 mg / m 2 d1~d5+cddp mg / m 2 d1 * 41 34 28 5 50.1 50.1 31 88.2(30 / 34) 7.8(19 / 28) 73.5(25 / 34) 50(14 / 28) [11] B 2005 GEM 1 000 mg / m 2 d1 d8+cbp 400 mg / m 2 d1 # 30 DOC 135 mg / m 2 d1+cddp 30 mg / m 2 d1~d3 # 30 30 30 > > >50 >50 52 59 13 Ma BB [12] 2002 A GEM 1 000 mg / m 2 d1 d8 d15 # 18 GEM 1 000 mg / m 2 d1 d8 d15+cddp 70 mg / m 2 d2 # 14 18 14 75 4 9 48(8 / 18) 9(9 / 14) 27(4 / 18) 35(4 / 14) Foo KF [13] 2002 A GEM 1 250 mg / m 2 d1 d8 * 25 GEM 1 250 mg / m 2 d1 d8+cddp * 27 25 27 5 4 7 13 20(5 / 25) 4(12 / 27) 8(2 / 25) 25(7 / 27) [14] C 200 GEM 0 mg / m 2 +OXA mg / m 2 d1 d8 GEM 0 mg / m 2 +OXA mg / m 2 d1 d8 55 55 15 8 95.2(19 / 25).7(14 / ) :*d / # 28 d / ;dn ;RT ;GEM: ;CDDP: ;5FU:5 ;CBP: ;DOC: 2.2 [1013] 4 2.2.1 [8101213] 8 RCT ;4 2 [791114] 2 [1213] RCT ;2 RCT (2) [1213] 8 RCT 2 RCT 2.2.3 ITT [913] 3 RCT 8 RCT 4 [1114] [710] Cochrane GP FP 2 [12 13 4.2.2 GP ] 1 GEM : 2 RCT A 3 B 3 C (2) 2.2.2 482 398 84 ; 21 2 ; [11] + CBP DOC + DDP 1 [14] 2.2.4 8 RCT (CR+PR) [71014] 190 292 2 7 RCT 1 RCT
. 15 2 / B [8] C [9] B Yau TK [10] C [11] B Ma BB [12] A Foo KF [13] A [14] C : : ;: ;: [7101213] 3 5 RCT 1 94.4%(135 / 143) FP [810 12 13] [10 14 2 RCT ] 88.5%(124 / 140) [RR=1.12 1 RCT 95%CI(0.881.42)P=0.37] RR [10] 2.3 2.3.1 GP FP 2.3.1.1 1 GP 3 FP 1 4 [RR=1.40 95%CI (0.952.07) ( 283 ) 1 ( P=0.09] ) 2.3.1.3 4 α=0.1 GP FP P=0.10 I 2 =55.9%>50% [RR=1.13 95%CI (1.021.25) P= GP 0.02] (1) 95%CI 1 2.3.1.2 3 4 1 GP FP 2.3.2 GEM GP 2.3.2.1 1 2 1 2.3.2.3 2 [1213] GEM [RR=1.81 [RR= 95%CI (1.03.08) P=0.03] (3) 1.78 95%CI(1.033.0)P=0.04] (2) 2.3.3 GEM + CBP DOC + DDP 2.3.2.2 3 2 [1213] 1 [11] GEM + CBP 3 DOC + DDP GEM [RR= 2005 2.01 95%CI (0.5.05) P =0.14]
1 2009 9 3 2 GEM GP 1 3 GEM GP GEM + CBP DOC + DDP 2 (P< GEM + CBP DOC + DDP 1 0.01)GEM + CBP (70.0%) DOC + DDP (43.3%) 2.3.4 GP FP 1 [14] 1 3 5 GP 1 GEM 3 DDP 5FU 42 GEM + CBP DOC + DDP 71.4% 38.1% (P=0.030); 1 95.2%.7% 1 (P= 0.018); 1 14 (P=0.013) ; 3 8 RCT 5 3 4 GP FP 2 GP 1 FP RCT
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