Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, Zhejiang Province, China.
Institute of Gastroenterology, Zhejiang University, Hangzhou, Zhejiang Province, China.
J Dig Dis. 2018 Dec;19(12):737-744. doi: 10.1111/1751-2980.12682. Epub 2018 Dec 13.
Whether endoscopic surveillance would improve the outcomes of esophageal adenocarcinoma in patients previously diagnosed with Barrett's esophagus remains unclear. This meta-analysis aimed to assess the survival advantages of endoscopic surveillance for patients with Barrett's esophagus.
Databases including PubMed, the Web of Science, and the Cochrane Library were examined systematically from their inception to July 2017, for articles related to the survival outcomes of esophageal adenocarcinoma in patients with Barrett's esophagus under endoscopic surveillance. Adjusted hazard estimates were adopted to determine overall results with 95% confidence intervals (CIs), using the fixed-effect model. We conducted subgroup and sensitivity analyses using the "metan" command in Stata software to assess the stability of the overall results. Begg's test, Egger's test and the funnel plot were used to evaluate the presence of publication bias.
A total of eight studies (two case-control and six cohort studies) were finally included in our current study. Compared with patients with esophageal adenocarcinoma that was not detected by surveillance, a significant 29% reduction in mortality from esophageal adenocarcinoma was observed among patients under endoscopic surveillance (adjusted hazard ratio [HR] 0.71, 95% CI 0.66-0.77). This effect was presented in both the USA (adjusted HR 0.71, 95% CI 0.65-0.78) and Europe (adjusted HR 0.71, 95% CI 0.60-0.83). We found no evidence of publication bias.
Our meta-analysis supports the concept that endoscopic surveillance for patients with Barrett's esophagus could improve the prognosis of esophageal adenocarcinoma. More well-designed prospective studies are needed to confirm this association.
内镜监测是否能改善先前被诊断为 Barrett 食管的患者的食管腺癌结局尚不清楚。本荟萃分析旨在评估内镜监测对 Barrett 食管患者的生存优势。
系统检索 PubMed、Web of Science 和 Cochrane Library 数据库，检索时限均从建库至 2017 年 7 月，收集有关内镜监测下 Barrett 食管患者食管腺癌生存结局的相关研究。采用固定效应模型，使用“metan”命令进行亚组和敏感性分析，以确定调整后的危险比及其 95%置信区间（CI）作为总体结果。采用 Begg 检验、Egger 检验和漏斗图评估发表偏倚的存在。
最终纳入 8 项研究（2 项病例对照研究和 6 项队列研究）。与未通过监测检出的食管腺癌患者相比，接受内镜监测的患者食管腺癌死亡率显著降低 29%（调整后的危险比 [HR] 0.71，95%CI 0.66-0.77）。这一效果在美国（调整后的 HR 0.71，95%CI 0.65-0.78）和欧洲（调整后的 HR 0.71，95%CI 0.60-0.83）均存在。未发现发表偏倚的证据。
本荟萃分析支持内镜监测 Barrett 食管患者可改善食管腺癌预后的观点。需要更多设计良好的前瞻性研究来证实这种关联。
