Petrelli Fausto, Berenato Rosa, Turati Luca, Mennitto Alessia, Steccanella Francesca, Caporale Marta, Dallera Pierpaolo, de Braud Filippo, Pezzica Ezio, Di Bartolomeo Maria, Sgroi Giovanni, Mazzaferro Vincenzo, Pietrantonio Filippo, Barni Sandro
Medical Oncology Unit, Oncology Department, ASST Bergamo Ovest, Treviglio (BG), Italy.
Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
J Gastrointest Oncol. 2017 Feb;8(1):148-163. doi: 10.21037/jgo.2017.01.10.
There are two distinct types of gastric carcinoma (GC), intestinal, more frequently sporadic and linked to environmental factors, and diffuse (undifferentiated) that is highly metastatic and characterized by rapid disease progression and a poor prognosis. However, there are many conflicting data in the literature concerning the association between histology and prognosis in GC. This meta-analysis was performed to provide demonstration if histology according to Lauren classification is associated with different prognosis in patients with GC.
We searched PubMed, the Cochrane Library, SCOPUS, Web of Science, CINAHL, and EMBASE for all eligible studies. The combined hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) in terms of overall survival (OS) were evaluated.
A total of 73 published studies including 61,468 patients with GC were included in this meta-analysis. Our analysis indicates that GC patients with diffuse-type histology have a worst prognosis than those with intestinal subgroup in all studies (HR 1.23; 95% CI, 1.17-1.29; P<0.0001), in both loco-regional confined (HR 1.21; 95% CI, 1.12-1.30; P<0.0001) and advanced disease (HR 1.25; 95% CI, 1.046-1.50; P=0.014), in Asiatic (HR 1.2; 95% CI, 1.14-1.27; P<0.0001) and Western patients (HR 1.3; 95% CI, 1.19-1.41; P<0.0001), and in those not exposed (HR 1.15; 95% CI, 1.07-1.24; P<0.0001) or exposed (HR 1.27; 95% CI, 1.17-1.37; P<0.0001) to (neo)adjuvant therapy.
Our results indicated that histology might be a useful prognostic marker for both early and advanced GC patients, with intestinal-type associated with a better outcome. This information could be used for stratification purpose in future clinical trials.
胃癌（GC）有两种不同类型，即肠型，更常见为散发性，与环境因素有关；以及弥漫型（未分化型），具有高度转移性，其特征为疾病进展迅速且预后不良。然而，关于GC组织学与预后之间的关联，文献中有许多相互矛盾的数据。进行这项荟萃分析是为了证实根据劳伦分类法的组织学是否与GC患者的不同预后相关。
我们在PubMed、Cochrane图书馆、SCOPUS、科学网、CINAHL和EMBASE中检索了所有符合条件的研究。评估了总生存期（OS）方面的合并风险比（HRs）及其相应的95%置信区间（CIs）。
本荟萃分析共纳入73项已发表研究，包括61468例GC患者。我们的分析表明，在所有研究中，弥漫型组织学的GC患者预后比肠型亚组患者更差（HR 1.23；95% CI，1.17 - 1.29；P < 0.0001），在局部区域局限型（HR 1.21；95% CI，1.12 - 1.30；P < 0.0001）和晚期疾病（HR 1.25；95% CI，1.046 - 1.50；P = 0.014）患者中均如此，在亚洲患者（HR 1.2；95% CI，1.14 - 1.27；P < 0.0001）和西方患者（HR 1.3；95% CI，1.19 - 1.41；P < 0.0001）中也是如此，在未接受（HR 1.15；95% CI，1.07 - 1.24；P < 0.0001）或接受（HR 1.27；95% CI，1.17 - 1.37；P < 0.0001）（新）辅助治疗的患者中同样如此。
我们的结果表明，组织学可能是早期和晚期GC患者有用的预后标志物，肠型与较好的预后相关。该信息可用于未来临床试验的分层目的。
