Bang Chang Seok, Choi Jae Ho, Lee Jae Jun, Baik Gwang Ho
Department of Internal Medicine.
Institute of New Frontier Research.
Medicine (Baltimore). 2018 Dec;97(52):e13905. doi: 10.1097/MD.0000000000013905.
Endoscopic submucosal dissection (ESD) is a primary treatment for the early gastric cancer (EGC) who has a negligible risk of lymph node metastasis. Papillary adenocarcinoma (PAC) of stomach is a rare histologic variant of gastric cancer and categorized into EGC with differentiated-histology. However, aggressive features such as higher rate of lymphovascular invasion (LVI) or submucosal invasion have been reported, whereas comparable lymph node metastasis (LNM) rate to the lesions meeting the current ESD criteria also has been reported. This study aimed to evaluate the feasibility of ESD for EGC with PAC.
We will search the core databases (MEDLINE (through PubMed), the Cochrane Library, and Embase) from their inception to December 2018 by 2 independent evaluators. The P.I.C.O. is as follows; Patients: who have EGC with PAC, Intervention: ESD or surgery, Comparison: none, Outcome: at least one among the rate of complete resection, curative resection, en bloc resection, recurrence, procedure-related adverse event, LVI or LNM that enabled an evaluation of the feasibility of ESD. All types of study design with full text will be sought and included. The risk of bias will be assessed using the ROBINS-I tool. Descriptive data synthesis is planned, and quantitative synthesis will be used if the included studies are sufficiently homogenous. Publication bias will be assessed with quantitative analyses if more than 10 articles are enrolled.
The results will provide evidence for efficacy and safety of ESD for EGC with PAC.
This study will provide evidence of ESD for EGC with PAC.
内镜黏膜下剥离术（ESD）是早期胃癌（EGC）的主要治疗方法，这类患者发生淋巴结转移的风险可忽略不计。胃乳头状腺癌（PAC）是胃癌的一种罕见组织学变体，属于组织学分化型的EGC。然而，有报道称其具有侵袭性特征，如较高的淋巴管侵犯（LVI）或黏膜下侵犯率，同时也有报道称其淋巴结转移（LNM）率与符合当前ESD标准的病变相当。本研究旨在评估ESD治疗EGC合并PAC的可行性。
两名独立评估人员将检索核心数据库（MEDLINE（通过PubMed）、Cochrane图书馆和Embase），检索时间从建库至2018年12月。PICO如下：患者：患有EGC合并PAC的患者；干预措施：ESD或手术；对照：无；结局指标：完全切除率、根治性切除率、整块切除率、复发率、手术相关不良事件、LVI或LNM中的至少一项，以评估ESD的可行性。将检索并纳入所有具有全文的研究设计类型。将使用ROBINS-I工具评估偏倚风险。计划进行描述性数据综合分析，如果纳入的研究足够同质，则将使用定量综合分析。如果纳入超过10篇文章，将通过定量分析评估发表偏倚。
结果将为ESD治疗EGC合并PAC的有效性和安全性提供证据。
本研究将为ESD治疗EGC合并PAC提供证据。
