目的 運(yùn)用Meta分析方法，評(píng)價(jià)老年晚期胃癌患者一線應(yīng)用替吉奧（或聯(lián)合奧沙利鉑）與卡培他濱（或聯(lián)合奧沙利鉑）化療的療效與安全性。方法 檢索Cochrane library、pubmed、ovid（elsevier）、中國(guó)期刊全文數(shù)據(jù)庫(kù)、維普數(shù)據(jù)庫(kù)、萬(wàn)方資源數(shù)據(jù)和中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)系統(tǒng)，對(duì)納入的隨機(jī)對(duì)照試驗(yàn)（RCT），根據(jù)Cochrane Handbook 5.1進(jìn)行文獻(xiàn)質(zhì)量評(píng)價(jià)，并運(yùn)用RevMan 5.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。主要結(jié)局指標(biāo)為有效率、不良反應(yīng)發(fā)生率，采用相對(duì)危險(xiǎn)度（RR）為效應(yīng)量，各效應(yīng)量以95%置信區(qū)間（95% CI）表示。結(jié)果 共納入6項(xiàng)RCT，332例老年胃癌患者，其中2項(xiàng)RCT為聯(lián)合奧沙利鉑化療組，4項(xiàng)RCT為單藥治療組。Meta分析結(jié)果顯示，無(wú)論是否聯(lián)合奧沙利鉑化療，應(yīng)用替吉奧與卡培他濱治療后療效相當(dāng)（RR=1.10，95% CI：0.84～1.45，P=0.49）；亞組分析（單藥組），納入4項(xiàng)RCT，213例患者，結(jié)果顯示單藥組替吉奧與卡培他濱的有效率差異無(wú)顯著性（RR=1.19，95% CI：0.81～1.74，P=0.92），但替吉奧組3度以上手足綜合癥（HFS）的發(fā)生率明顯低于卡培他濱組（RR=0.11，95% CI：0.01～0.87，P=0.04）。結(jié)論 無(wú)論是否聯(lián)合奧沙利鉑化療，替吉奧在老年胃癌患者中在有效率方面與卡培他濱療效相當(dāng)，替吉奧單藥組3度以上的HFS的發(fā)生率明顯較低，替吉奧是老年晚期胃癌患者的較佳選擇。但由于研究例數(shù)較少，該結(jié)論有待進(jìn)一步加大樣本量進(jìn)行證實(shí)。

Objective To evaluate the effectiveness and safety of S-1 (or with oxaliplatin) versus capecitabine (or with oxaliplatin) in elderly advanced gastric cancer by meta-analysis. Methods The Cochrane Library, Ovid, Pubmed, CNKI, VIP, WanFang, CBM, etc were retrieved by computer, and the quality assessment of qualified random control trials (RCTs) were evaluated according to Cochrane Handbook 5.1 and statistic analysis was carried out by RevMan 5.0 software. The outcomes included response rate and incidence of adverse reactions. Relative risk (RR) was used for the meta-analysis and was expressed with 95% confidence intervals (95% CI). Results A total of six RCTs and 332 elderly patients with advanced gastric cancer were included in this review, of which four RCTs were treated with single drug regimen of S-1 or capecitabine and two RCTs were treated with oxaliplatin-based combined chemotherapy. Meta-analysis indicated that there were no statistical differences between S-1 and capecitabine regimens in the response rate whether combined with oxaliplatin or not (RR = 1.10, 95% CI: 0.84—1.45, P = 0.49). Subgroup meta-analysis of single drug regimen indicated that there were no statistical differences between S-1 and capecitabine (RR = 1.19, 95% CI: 0.81—1.74, P = 0.92). However, the incidence of grade 3/4 toxicities of Hand-Foot-syndrome was obviously decreased in S-1 regimen (RR = 0.11, 95% CI: 0.01—0.87, P = 0.04). Conclusion S-1 is as effective as capecitabine in elderly advanced gastric cancer patients, whether combined with oxaliplatin or not. Moreover, the single drug S-1 which has a lower incidence of grade 3/4 toxicities of Hand-Foot-syndrome, can be the better choice for elderly advanced gastric cancer patients. The conclusion remains to be confirmed with more high quality RCTs.