Meta_Analysis在肿瘤循证医学中的应用_英文(6)

Chin J Clin Oncol (2008) 5: 1~9

Screeningproves survival in patients with HCC, it is not known if transarterial chemoembolization combined with other treatments is beneficial. Marelli et al.[44] used the meta-analysis method and concluded that a combined approach involving transarterial chemoembolization and percutaneous ablation improves survival. Adju-vant transarterial injection of chemotherapeutic drugs mixed with lipiodol improves outcome after hepa-tectomy. Transarterial chemoembolization is useful to control a tumor burden while the patient is on a waiting list for orthotopic liver transplantation. Multi-modal treatment seems to be the best way to optimize transarterial chemoembolization outcomes in HCC. For the purpose assessing the validity of the measure-ment of pepsinogen I and II as a screening test for gastric cancer and pre-malignant lesions, namely low-grade dysplasia, both in the general population and in selected groups of patients, Dinis-Ribeiro et al.[49] pooled 42 data sets including 27 (64%) population-based screening studies (n=296,553) and 15 (36%) sets of selected individuals (n=4,385). A pepsinogen test definition should include the pepsinogen I/II ratio due to its consistent result. Further studies of this test in the management of high-risk patients seem to be worthwhile.

Therapy Evidence-Based Oncology for Stomach

Cancer

EtiologyLarsson et al.[45] analyzed the association between processed meat consumption and stomach cancer risk in a meta-analysis. Increased consumption of processed meat is associated with an increased risk of stomach cancer, but the possibility that the associa-tion may be confounded or modified by other factors cannot be ruled out. It has been suggested that consumption of soy foods may be associated with a reduction in risk of various cancers. Wu et al.[46] conducted a pooled analysis of 14 studies with data on eating fermented soy foods. They showed an OR/RR of 1.26 (95% CI=1.11~1.43) for stomach cancer in association with high intake of such foods. In contrast, the pooled analysis of 10 studies with data on non-fermented soy foods found an OR/RR of 0.72 (95% CI=0.63~0.82) in association with a high intake of these foods. How-ever, the authors reminded the readers that the results were not adjusted for salt, fruit and vegetable intake. Based on a meta-analysis conducted by Lunet et al.[47] fruit or vegetable intake was associated with a decreased risk of gastric cancer regardless of the ana-tomical location and the histological type, although dietary intake had a more clear-cut protective effect on intestinal-type cancers. Wang et al.[48] conducted a meta-analysis on the as-sociation between Helicobacter pylori infection and early gastric cancer (EGC). This study indicated that H. pylori infection is strongly associated with EGC when compared with non-neoplasm controls or ad-vanced gastric cancer. To determine more accurately the extent of H. pylori in EGC, age-matched normal controls or adjustment for age in the analysis should be considered in H. pylori-related gastric cancer case-control studies. Hosono et al.[50] analyzed short-term outcomes of 1,611 procedures from 4 randomized controlled trials and 12 retrospective studies after laparoscopy-assist-ed distal gastrectomy. Laparoscopy-assisted distal gastrectomy for early gastric cancer is associated with a lower morbidity, less pain, faster bowel function re-covery, and shorter hospital stay. Assessment of the efficacy and tolerability of che-motherapy in patients with advanced gastric cancer was studied in a systematic review by using meta-analysis by Wagner et al.[51] Best survival results are achieved with 3-drug regimens containing fluoro-uracil (FU), an anthracycline, and cisplatin. Among these, regimens including FU as a bolus exhibited a higher rate of toxic deaths than regimens using a con-tinuous infusion of FU, such as epirubicin, cisplatin, and continuous-infusion FU. Casaretto et al.[52] conducted a meta-analysis to compare the efficacy of chemotherapy and support treatment in patients with advanced non-resectable gastric cancer. Five studies fulfilled the inclusion criteria, for a total of 390 participants, 208 (53%) re-ceiving chemotherapy, 182 (47%) receiving support care treatment and 6 losses (1.6%). Chemotherapy increased the 1-year survival rate of the patients and provided a longer symptom-free period of 6 months and an improvement in quality of life. Evidence-Based Oncology for Cancer of the CervixEtiologyCastellsague, et al.[53] pooled data from 8 case-control studies of cervical cancer. A total of 167 cases with invasive cervical adenocarcinoma (112 with adeno-carcinoma and 55 with adenosquamous carcinoma) and 1,881 hospital-based control subjects were in-cluded. The adjusted overall OR for cervical adeno-

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