Department General Surgery and Surgical Oncology, University of Siena, Siena, Italy.
Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland.
Br J Surg. 2018 Feb;105(3):159-167. doi: 10.1002/bjs.10663. Epub 2017 Nov 1.
Several associations between microsatellite instability (MSI) and other clinicopathological factors have been reported in gastric cancer, but the results have been ambiguous. This systematic review and meta-analysis investigated the relationship between MSI and overall survival and clinicopathological characteristics of patients with gastric cancer.
A systematic literature search of the PubMed, Cochrane and Ovid databases until 31 January 2016 was performed in accordance with the PRISMA statement. The articles were screened independently according to PICO (population, intervention, comparator, outcome) eligibility criteria. All eligible articles were evaluated independently by two reviewers for risk of bias according to the Quality In Prognosis Study tool.
Overall, 48 studies with a total of 18 612 patients were included. MSI was found in 9·2 per cent of patients (1718 of 18 612), and was associated with female sex (odds ratio (OR) 1·57, 95 per cent c.i. 1·31 to 1·89; P < 0·001), older age (OR 1·58, 2·20 to 1·13; P < 0·001), intestinal Laurén histological type (OR 2·23, 1·94 to 2·57; P < 0·001), mid/lower gastric location (OR 0·38, 0·32 to 0·44; P < 0·001), lack of lymph node metastases (OR 0·70, 0·57 to 0·86, P < 0·001) and TNM stage I-II (OR 1·77, 1·47 to 2·13; P < 0·001). The pooled hazard ratio for overall survival of patients with MSI versus those with non-MSI gastric cancer from 21 studies was 0·69 (95 per cent c.i. 0·56 to 0·86; P < 0·001).
MSI in gastric cancer was associated with good overall survival, reflected in several favourable clinicopathological tumour characteristics.
多项研究报道了微卫星不稳定性（MSI）与胃癌其他临床病理因素之间存在关联，但结果并不明确。本系统综述和荟萃分析旨在探讨 MSI 与胃癌患者总生存率及临床病理特征之间的关系。
我们根据 PRISMA 声明，对截至 2016 年 1 月 31 日的 PubMed、Cochrane 和 Ovid 数据库进行了系统文献检索。根据 PICO（人群、干预、对照、结局）标准筛选文章。所有符合条件的文章均根据质量预后研究工具独立进行了两位评审员的偏倚风险评估。
共纳入 48 项研究，总计 18612 例患者。MSI 发生率为 9.2%（1718/18612），与女性（优势比[OR] 1.57，95%置信区间[CI] 1.31 至 1.89；P<0.001）、高龄（OR 1.58，2.20 至 1.13；P<0.001）、肠型Laurén 组织学类型（OR 2.23，1.94 至 2.57；P<0.001）、胃中/下部位置（OR 0.38，0.32 至 0.44；P<0.001）、无淋巴结转移（OR 0.70，0.57 至 0.86，P<0.001）和 TNM Ⅰ-Ⅱ期（OR 1.77，1.47 至 2.13；P<0.001）相关。21 项研究中 MSI 与非 MSI 胃癌患者的总生存率汇总风险比为 0.69（95%CI 0.56 至 0.86；P<0.001）。
胃癌中 MSI 与较好的总生存率相关，这反映在多个有利的临床病理肿瘤特征中。
