姑息性胃切除术联合化疗与单纯化疗治疗不可治愈的晚期胃癌：一项荟萃分析
Palliative gastrectomy plus chemotherapy versus chemotherapy alone for incurable advanced gastric cancer: a meta-analysis.
作者信息
Wu Pei, Wang Pengliang, Ma Bin, Yin Songcheng, Tan Yuen, Hou Wenbin, Wang Zhenning, Xu Huimian, Zhu Zhi
机构信息
Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, China,
Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Dadong District, Shenyang 110042, Liaoning Province, China.
出版信息
Cancer Manag Res. 2018 Oct 26;10:4759-4771. doi: 10.2147/CMAR.S179368. eCollection 2018.
BACKGROUND
Whether palliative gastrectomy combined with chemotherapy can improve the survival of patients with advanced gastric cancer remains controversial. We performed a meta-analysis to clarify whether palliative gastrectomy plus chemotherapy can benefit patients with incurable advanced gastric cancer and to explore the best candidates in this patient population.
METHODS
We searched the literature systematically using electronic databases including PubMed, EMBASE, and the Cochrane Library. And HRs and their 95% CIs were used to express the results for overall survival (OS) and progression-free survival (PFS).
RESULTS
One randomized controlled trial with 175 patients and 12 cohort studies with 2,193 patients were analyzed. The pooled HR for OS (HR=0.43, 95% CI=0.29-0.65, <0.001), subgroup analysis of stage M1 (HR=0.53, 95% CI=0.40-0.72, <0.001), peritoneal dissemination (HR=0.46, 95% CI=0.28-0.73, =0.001), and liver metastasis (HR=0.46, 95% CI=0.33-0.65, <0.001) all indicated the superiority of palliative gastrectomy plus chemotherapy. However, the pooled HR for PFS (HR=0.61, 95% CI=0.33-1.13, =0.110) got separate outcome.
CONCLUSION
The results of this meta-analysis indicated that palliative gastrectomy plus chemotherapy can improve OS for incurable advanced gastric cancer. In addition, analyses based on liver metastasis and peritoneal dissemination demonstrated the advantages of palliative gastrectomy plus chemotherapy. However, the PFS of incurable advanced gastric cancer with palliative gastrectomy plus chemotherapy was no better than that under chemotherapy alone.
背景
姑息性胃切除术联合化疗能否提高晚期胃癌患者的生存率仍存在争议。我们进行了一项荟萃分析，以阐明姑息性胃切除术加化疗是否能使无法治愈的晚期胃癌患者获益，并探索该患者群体中的最佳候选者。
方法
我们使用包括PubMed、EMBASE和Cochrane图书馆在内的电子数据库系统地检索文献。采用风险比（HR）及其95%置信区间（CI）来表示总生存期（OS）和无进展生存期（PFS）的结果。
结果
分析了一项包含175例患者的随机对照试验和12项包含2193例患者的队列研究。OS的合并HR（HR=0.43，95%CI=0.29-0.65，<0.001）、M1期亚组分析（HR=0.53，95%CI=0.40-0.72，<0.001）、腹膜播散（HR=0.46，95%CI=0.28-0.73，=0.001）和肝转移（HR=0.46，95%CI=0.33-0.65，<0.001）均表明姑息性胃切除术加化疗的优越性。然而，PFS的合并HR（HR=0.61，95%CI=0.33-1.13，=0.110）得出了不同的结果。
结论
这项荟萃分析的结果表明，姑息性胃切除术加化疗可改善无法治愈的晚期胃癌患者的OS。此外，基于肝转移和腹膜播散的分析显示了姑息性胃切除术加化疗的优势。然而，姑息性胃切除术加化疗的无法治愈的晚期胃癌患者的PFS并不优于单纯化疗。
Zotero 插件