Efficacy And Safety Of Docetaxel Or Epirubicin Based Chemotherapy Regimens In The Treatment Of Advanced Gastric Cancer: A Meta-analysis

Objective: To systematically review the efficacy and safety of docetaxel or epirubicin based regimens in the treatment of advanced gastric cancer.Methods: We searched EMbase,PubMed,The Cochrane Library,Web of science,CBM,CNKI and WanFang Data from inception to December 2017,to collect randomized controlled trials(RCTs)on docetaxel or epirubicin based regimens in the treatment of advanced gastric cancer.Two reviewers independently screened literature,extracted data and evaluated included studies quality.Using RevMan 5.3 software to conduct meta-analysis.Results: A total of 12 RCTs involving 984 advanced gastric cancer patients were included,of which 508 patients received docetaxel based regimens,476 patients received epirubicin based regimens.The results of meta-analysis showed that docetaxel based regimens were superior to epirubicin based regimens in objective response rate(ORR)[RR=1.21,95%CI(1.02,1.43),P=0.03],disease control rate(DCR)[RR=1.13,95%CI(1.01,1.26),P=0.03],1-year survival rate [RR=1.26,95%CI(1.01,1.56),P=0.04] and 2-year survival rate [RR=3.03,95%CI(1.59,5.75),P=0.000 7],while there were no statistical difference between two groups in the incidence of grade III to IV adverse events,including leukopenia [RR=0.87,95%CI(0.63,1.19),P=0.38],neutropenia [RR=1.01,95%CI(0.65,1.56),P=0.97],thrombocytopenia [RR=1.06,95%CI(0.33,3.39),P=0.92],anemia [RR=1.26,95%CI(0.72,2.19),P=0.42],anorexia [RR=1.14,95%CI(0.59,2.20),P=0.69],nausea/vomiting [RR=0.92,95%CI(0.58,1.45),P=0.71],fatigue [RR=0.61,95%CI(0.23,1.63),P=0.32],diarrhea [RR=1.37,95%CI(0.57,3.29),P=0.48],stomatitis[RR=2.29,95%CI(0.94,5.57),P=0.07],hand and foot syndrome [RR=0.62,95%CI(0.14,2.68),P=0.52],peripheral neuritis [RR=1.19,95%CI(0.31,4.51),P=0.80] and febrile neutropenia [RR=2.36,95%CI(0.62,8.96),P=0.21].Eliminating 7 Chineseliteratures with high bias risk,the results of sensitivity analysis showed that docetaxel based regimens were superior to epirubicin based regimens in 2-year survival rate[RR=2.56,95%CI(1.06,6.19),P=0.04],but there were no statistical differences in ORR [RR=1.13,95%CI(0.88,1.45),P=0.34],DCR [RR=1.02,95%CI(0.85,1.21),P=0.84] and 1-year survival rate [RR=1.29,95%CI(0.92,1.80),P=0.14].The results of sensitivity analysis showed that the overall outcomes might be affected by the risk bias of included studies.The comparision between docetaxel based regimens and epirubicin based regimens was consistent with the overall outcomes in the incidence of grade III to IV adverse events,including leukopenia [RR=0.84,95%CI(0.57,1.23),P=0.38],neutropenia [RR=0.96,95%CI(0.49,1.86),P=0.89],thrombocytopenia[RR=0.31,95%CI(0.04,2.28),P=0.25],anemia [RR=0.86,95%CI(0.27,2.68),P=0.79],nausea/vomiting [RR=1.08,95%CI(0.57,2.05),P=0.82],fatigue [RR=0.77,95%CI(0.18,3.35),P=0.73],diarrhea [RR=1.68,95%CI(0.53,5.31),P=0.38],stomatitis [RR=1.98,95%CI(0.25,15.52),P=0.52],peripheral neuritis [RR=0.90,95%CI(0.20,4.12),P=0.89] and febrile neutropenia [RR=1.43,95%CI(0.29,6.98),P=0.66].Conclusion: Compared with epirubicin based regimens,docetaxel based regimens may have more clinical benefits for advanced gastric cancer patients.