胃癌患者腹腔内游离肿瘤细胞与预后：一项系统评价和荟萃分析
Free intraperitoneal tumor cells and outcome in gastric cancer patients: a systematic review and meta-analysis.
作者信息
Pecqueux Mathieu, Fritzmann Johannes, Adamu Mariam, Thorlund Kristian, Kahlert Christoph, Reißfelder Christoph, Weitz Jürgen, Rahbari Nuh N
机构信息
Department for Visceral, Thoracic and Vascular Surgery, University of Dresden, Dresden, Germany.
Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.
出版信息
Oncotarget. 2015 Nov 3;6(34):35564-78. doi: 10.18632/oncotarget.5595.
PURPOSE
Despite continuously improving therapies, gastric cancer still shows poor survival in locally advanced stages with local recurrence rates of up to 50% and peritoneal recurrence rates of 17% after curative surgery. We performed a systematic review with meta-analyses to clarify whether positive intraperitoneal cytology (IPC) indicates a high risk of disease recurrence and poor overall survival in gastric cancer.
METHODS
Multiple databases were searched in December 2014 to identify studies on the prognostic significance of positive intraperitoneal cytology in gastric cancer, including: Medline, Biosis, Science Citation Index, Embase, CCMed and publisher databases. Hazard ratios (HR) and associated 95% confidence intervals (CI) were extracted from the identified studies. A meta-analysis was performed using a random-effects model on overall survival, disease-free survival and peritoneal recurrence free survival.
RESULTS
A total of 64 studies with a cumulative sample size of 12,883 patients were included. Cytology, quantitative real time polymerase chain reaction (PCR) or both were performed in 35; 21 and 8 studies, respectively. Meta analyses revealed free intraperitoneal tumor cells (FITC) to be associated with poor overall survival in univariate (HR 3.27; 95% CI 2.82 - 3.78]) and multivariate (HR 2.45; 95% CI 2.04 - 2.94) analysis and poor peritoneal recurrence free survival in univariate (4.15; 95% CI 3.10 - 5.57) and multivariate (3.09; 95% CI 2.02 - 4.71) analysis. Subgroup analysis showed this effect to be independent of the detection method, Western or Asian origin or the time of publication.
CONCLUSIONS
FITC oder positive peritoneal cytology is associated with poor survival and increased peritoneal recurrence in gastric cancer.
目的
尽管治疗方法不断改进，但局部晚期胃癌的生存率仍然较低，根治性手术后局部复发率高达50%，腹膜复发率为17%。我们进行了一项系统评价和荟萃分析，以阐明阳性腹腔细胞学检查（IPC）是否表明胃癌疾病复发风险高和总生存期差。
方法
2014年12月检索了多个数据库，以确定关于阳性腹腔细胞学检查在胃癌中的预后意义的研究，包括：医学文献数据库、生物学文摘数据库、科学引文索引数据库、荷兰医学文摘数据库、中国生物医学文献数据库和出版商数据库。从纳入的研究中提取风险比（HR）和相关的95%置信区间（CI）。采用随机效应模型对总生存期、无病生存期和无腹膜复发生存期进行荟萃分析。
结果
共纳入64项研究，累计样本量为12883例患者。分别在35项、21项和8项研究中进行了细胞学检查、定量实时聚合酶链反应（PCR）或两者均进行。荟萃分析显示，在单因素（HR 3.27；95%CI 2.82 - 3.78）和多因素（HR 2.45；95%CI 2.04 - 2.94）分析中，游离腹腔肿瘤细胞（FITC）与总生存期差相关，在单因素（4.15；95%CI 3.10 - 5.57）和多因素（3.09；95%CI 2.02 - 4.71）分析中与无腹膜复发生存期差相关。亚组分析表明，这种效应与检测方法、西方或亚洲来源或发表时间无关。
结论
FITC或阳性腹膜细胞学检查与胃癌生存率低和腹膜复发增加相关。
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