Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
Int J Surg. 2018 Aug;56:108-114. doi: 10.1016/j.ijsu.2018.06.016. Epub 2018 Jun 18.
The role of surgical resection for patients with recurrent or metastatic gastrointestinal stromal tumors is still controversial. This meta-analysis aims to investigate the clinical outcomes of surgery combined with tyrosine kinase inhibitors among patients with recurrent or metastatic gastrointestinal stromal tumors.
We systematically searched PubMed, EMBASE, the Cochrane Library and Wanfangdata without language restriction. Random effect models were used to estimate pooled hazard ratio and the corresponding 95% confidence intervals. Subgroup analyses, sensitivity analysis and trim and fill analysis were also performed.
A total of 1416 patient from 9 studies were finally enrolled in this meta-analysis. The summary results showed that surgery combined with tyrosine kinase inhibitors showed a tendency of a longer overall survival compared with tyrosine kinase inhibitors treatment alone (HR by random-effects model 0.68, 95% CI 0.54-0.85, I = 44.7%) and improved progress-free survival (HR by random-effects model 0.50,95% CI, 0.33-0.76, I = 17.9%). The trim and fill analysis and sensitive analysis indicated the relatively robust result.
Surgery combined with tyrosine kinase inhibitors therapy is associated with a better overall survival and progression free survival for patients with recurrent or metastatic gastrointestinal stromal tumors as compared with TKIs treatment alone.
手术切除在复发性或转移性胃肠道间质瘤患者中的作用仍存在争议。本荟萃分析旨在探讨手术联合酪氨酸激酶抑制剂治疗复发性或转移性胃肠道间质瘤患者的临床结局。
我们系统地检索了 PubMed、EMBASE、Cochrane 图书馆和万方数据库，不限制语言。采用随机效应模型估计合并的风险比及其相应的 95%置信区间。还进行了亚组分析、敏感性分析和修剪填充分析。
共有 9 项研究的 1416 名患者最终纳入本荟萃分析。汇总结果表明，与单独使用酪氨酸激酶抑制剂治疗相比，手术联合酪氨酸激酶抑制剂治疗有延长总生存期的趋势（随机效应模型 HR 为 0.68，95%CI 为 0.54-0.85，I²=44.7%），并改善了无进展生存期（随机效应模型 HR 为 0.50，95%CI 为 0.33-0.76，I²=17.9%）。修剪和填充分析和敏感分析表明结果相对稳健。
与单独使用 TKI 治疗相比，手术联合酪氨酸激酶抑制剂治疗与复发性或转移性胃肠道间质瘤患者的总生存期和无进展生存期的改善相关。
