Systematic review with network meta-analysis: adjuvant therapy for resected biliary tract cancer.
Aliment Pharmacol Ther
; 40(7): 759-70, 2014 Oct.
Article
em En
| MEDLINE
| ID: mdl-25099956
ABSTRACT
BACKGROUND:
Major adjuvant therapies for biliary tract cancer (BTC) include fluorouracil, gemcitabine and chemoradiation (CRT), but the optimum regimen remains inconclusive.AIM:
To compare these therapies in terms of patient survival rates after resection and toxic effects.METHODS:
We searched PubMed for controlled trials comparing the above three therapies with each other or observation alone until 31 January 2014. We estimated the hazard ratios (HRs) for death and odds ratios (ORs) for toxic effects among different therapies. Subgroup analyses based on positive lymph node or resection margin were also performed.RESULTS:
Twelve eligible articles were included. Gemcitabine improved 5-year survival (HR 2.12, 95% CI, confidence interval 1.23-4.02, P = 0.01), whereas fluorouracil (HR 1.61, 95% CI 0.74-3.67) and CRT (HR 1.55, 95% CI 0.82-3.32) provided a poorer survival outcome compared with gemcitabine after 1 year. Similarly, for 5-year survival rates, although differing, CRT did not provide a significant improvement in survival (HR 0.46, 95% CI 0.20-0.97) compared with gemcitabine. Fluorouracil did not appear to provide benefit over gemcitabine (HR 1.56, 95% CI 0.77-3.35). CRT was ranked highest for toxic effects including haematological (OR 5.45, 95% CI 0.01-483.85) and nonhaematological (OR 5.77, 95% CI 0.01-3807.40).CONCLUSIONS:
Chemotherapy with gemcitabine is the optimum adjuvant treatment with a balanced benefit-toxicity ratio for resected biliary tract cancer. Chemoradiation was more likely to cause toxic effects.
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
6_ODS3_enfermedades_notrasmisibles
Base de dados:
MEDLINE
Assunto principal:
Neoplasias do Sistema Biliar
/
Desoxicitidina
/
Quimiorradioterapia Adjuvante
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Fluoruracila
/
Antimetabólitos Antineoplásicos
Tipo de estudo:
Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
Aliment Pharmacol Ther
Ano de publicação:
2014
Tipo de documento:
Article