James Paul D, Meng Zhao Wu, Zhang Mei, Belletrutti Paul J, Mohamed Rachid, Ghali William, Roberts Derek J, Martel Guillaume, Heitman Steven J
Department of Medicine and the Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, Canada.
PLoS One. 2017 Mar 20;12(3):e0173687. doi: 10.1371/journal.pone.0173687. eCollection 2017.
It is unclear to what extent EUS influences the surgical management of patients with pancreatic adenocarcinoma. This systematic review sought to determine if EUS evaluation improves the identification of unresectable disease among adults with pancreatic adenocarcinoma.
We searched MEDLINE, EMBASE, bibliographies of included articles and conference proceedings for studies reporting original data regarding surgical management and/or survival among patients with pancreatic adenocarcinoma, from inception to January 7th 2017. Our main outcome was the incremental benefit of EUS for the identification of unresectable disease (IBEUS). The pooled IBEUS were calculated using random effects models. Heterogeneity was explored using stratified meta-analysis and meta-regression.
Among 4,903 citations identified, we included 8 cohort studies (study periods from 1992 to 2007) that examined the identification of unresectable disease (n = 795). Random effects meta-analysis suggested that EUS alone identified unresectable disease in 19% of patients (95% confidence interval [CI], 10-33%). Among those studies that considered portal or mesenteric vein invasion as potentially resectable, EUS alone was able to identify unresectable disease in 14% of patients (95% CI 8-24%) after a CT scan was performed.
The majority of the included studies were retrospective.
EUS evaluation is associated with increased identification of unresectable disease among adults with pancreatic adenocarcinoma.
目前尚不清楚超声内镜（EUS）在多大程度上影响胰腺腺癌患者的手术治疗管理。本系统评价旨在确定EUS评估是否能提高胰腺腺癌成年患者中不可切除疾病的识别率。
我们检索了MEDLINE、EMBASE、纳入文章的参考文献以及会议论文集，以查找自研究开始至2017年1月7日期间报告胰腺腺癌患者手术治疗管理和/或生存情况原始数据的研究。我们的主要结局是EUS在识别不可切除疾病方面的增量获益（IBEUS）。使用随机效应模型计算合并的IBEUS。采用分层Meta分析和Meta回归探索异质性。
在检索到的4903篇文献中，我们纳入了8项队列研究（研究时间段为1992年至2007年），这些研究对不可切除疾病的识别情况进行了检查（n = 795）。随机效应Meta分析表明，仅EUS就能识别出19%的患者患有不可切除疾病（95%置信区间[CI]，10 - 33%）。在那些将门静脉或肠系膜静脉侵犯视为可能可切除的研究中，在进行CT扫描后，仅EUS就能识别出14%的患者患有不可切除疾病（95% CI 8 - 24%）。
纳入的大多数研究为回顾性研究。
EUS评估与胰腺腺癌成年患者中不可切除疾病识别率的提高相关。
