Oncology Unit, Oncology Department, ASST Bergamo Ovest, Treviglio (BG), Italy.
Oncology Unit, Oncology Department, ASST Ospedale di Cremona, Cremona, Italy.
Ann Surg Oncol. 2017 Sep;24(9):2655-2668. doi: 10.1245/s10434-017-5832-4. Epub 2017 Mar 15.
The incidence of gastric cancer (GC) arising in the upper third of the stomach, including the cardia or gastroesophageal junction (GEJ), has increased in the last decades due to established etiological risk factors such as diet, obesity, and gastroesophageal reflux. We conducted a systematic review and meta-analysis to determine the prognostic role of site of origin in patients with proximal versus distal GC.
We conducted a search of the PubMed, Cochrane Library, SCOPUS, Web of Science, EMBASE, Google Scholar, LILACS, and CINAHL databases from inception to September 2016. Studies reporting data on the independent prognostic effect of site in GC and comparing overall survival (OS) in proximal versus distal tumors were eligible. Data were pooled using OS hazard ratios (HRs) of proximal versus distal GC according to fixed- or random-effect model.
Overall, 50 studies including 128,268 patients were identified. Cancers located in the upper third of the stomach were associated with a significantly increased risk of all-cause mortality (HR 1.31, 95% confidence interval [CI] 1.17-1.46, p < 0.001, I = 91%). After exclusion of GEJ tumors, prognosis was worse for pure cardia location (HR 1.39, 95% CI 1.22-1.58, p < 0.001, I = 61%) compared with proximal or upper-third GCs without a specific subsite definition (HR 1.18, 95% CI 1.01-1.37, p = 0.04, I = 91%).
Location of the primary GC in the upper third of the stomach, particularly at the GEJ/cardia, should be acknowledged as an important prognostic factor. Based on these results, more effective treatment strategies for proximal GCs are needed.
由于饮食、肥胖和胃食管反流等已确立的病因风险因素，过去几十年中，胃上部（包括贲门或胃食管交界处）发生的胃癌（GC）发病率有所增加。我们进行了系统评价和荟萃分析，以确定近端与远端 GC 患者起源部位的预后作用。
我们从建库到 2016 年 9 月，在 PubMed、Cochrane 图书馆、SCOPUS、Web of Science、EMBASE、Google Scholar、LILACS 和 CINAHL 数据库中进行了搜索。报告了 GC 中部位的独立预后作用数据，并比较了近端与远端肿瘤总生存（OS）的研究符合纳入标准。根据固定或随机效应模型，使用近端与远端 GC 的 OS 风险比（HR）对数据进行汇总。
总体而言，确定了 50 项研究，包括 128268 名患者。位于胃上部的癌症与全因死亡率增加显著相关（HR 1.31，95%置信区间 [CI] 1.17-1.46，p < 0.001，I 2 = 91%）。排除 GEJ 肿瘤后，与近端或无特定亚部位定义的上三分之一 GC（HR 1.18，95%CI 1.01-1.37，p = 0.04，I 2 = 91%）相比，纯贲门位置的预后更差（HR 1.39，95%CI 1.22-1.58，p < 0.001，I 2 = 61%）。
胃上部原发性 GC 的位置，特别是在 GEJ/贲门处，应被视为一个重要的预后因素。基于这些结果，需要为近端 GC 制定更有效的治疗策略。
