肿瘤芽生对胃癌的预后和病理影响：一项系统评价与荟萃分析。
Prognostic and pathological impact of tumor budding in gastric cancer: A systematic review and meta-analysis.
作者信息
Guo Yi-Xian, Zhang Zi-Zhen, Zhao Gang, Zhao En-Hao
机构信息
Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China.
出版信息
World J Gastrointest Oncol. 2019 Oct 15;11(10):898-908. doi: 10.4251/wjgo.v11.i10.898.
BACKGROUND
Tumor budding, is a promising prognostic hallmark in many cancers, and can help us better assess the degree of malignancy in gastric cancer (GC) and in colorectal cancer. In the past few years, several articles on the relationship between tumor budding and GC have been published, but different results have been observed. As the relationship between tumor budding and GC remains controversial, we integrated the data from 7 eligible studies to conduct a systematic review and meta-analysis.
AIM
To systematically evaluate the prognostic and pathological impact of tumor budding in GC.
METHODS
Literature searches were conducted in the PubMed, Cochrane Library, EMBASE and Web of Science databases, and 7 cohort studies involving 2178 patients met our criteria and included in the analysis. The patients were divided into those with high-grade tumor budding and those with low-grade tumor budding, and the cut-off values for tumor budding varied across the included studies. The hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to estimate the impact of tumor budding on overall survival (OS) in GC patients. The odds ratios (ORs) with 95%CIs were used to determine the correlation between tumor budding and pathological parameters (tumor stage, tumor differentiation, lymphovascular invasion, lymph node metastasis) of GC.
RESULTS
Seven studies involving 2178 patients were included in the meta-analysis. The combined ORs suggested that high-grade tumor budding was significantly associated with tumor stage (OR = 6.63, 95%CI: 4.01-10.98, < 0.01), tumor differentiation (OR = 3.74, 95%CI: 2.68-5.22, < 0.01), lymphovascular invasion (OR = 7.85, 95%CI: 5.04-12.21, < 0.01), and lymph node metastasis (OR = 5.75, 95%CI: 3.20-10.32, < 0.01). Moreover, high-grade tumor budding predicted a poor 5-year OS (HR = 1.79, 95%CI: 1.53-2.05, < 0.01) in patients with GC and an adverse 5-year OS (HR = 1.93, 95%CI: 1.45-2.42, < 0.01) in patients with intestinal-type GC.
CONCLUSION
High-grade tumor budding suggested a poor prognosis in patients with GC or intestinal-type GC.
背景
肿瘤芽生是许多癌症中一个有前景的预后标志，有助于我们更好地评估胃癌（GC）和结直肠癌的恶性程度。在过去几年里，已经发表了几篇关于肿瘤芽生与GC关系的文章，但观察到了不同的结果。由于肿瘤芽生与GC之间的关系仍存在争议，我们整合了7项符合条件的研究的数据，进行了系统评价和荟萃分析。
目的
系统评价肿瘤芽生对GC患者的预后和病理影响。
方法
在PubMed、Cochrane图书馆、EMBASE和Web of Science数据库中进行文献检索，7项涉及2178例患者的队列研究符合我们的标准并纳入分析。患者被分为高等级肿瘤芽生组和低等级肿瘤芽生组，纳入研究中肿瘤芽生的截断值各不相同。计算95%置信区间（CI）的风险比（HR），以估计肿瘤芽生对GC患者总生存期（OS）的影响。使用95%CI的优势比（OR）来确定肿瘤芽生与GC的病理参数（肿瘤分期、肿瘤分化、淋巴管侵犯、淋巴结转移）之间的相关性。
结果
7项涉及2178例患者的研究纳入荟萃分析。合并后的OR表明，高等级肿瘤芽生与肿瘤分期（OR = 6.63，95%CI：4.01 - 10.98，P < 0.01）、肿瘤分化（OR = 3.74，95%CI：2.68 - 5.22，P < 0.01）、淋巴管侵犯（OR = 7.85，95%CI：5.04 - 12.21，P < 0.01）和淋巴结转移（OR = 5.75，95%CI：3.20 - 10.32，P < 0.01）显著相关。此外，高等级肿瘤芽生预示GC患者5年OS较差（HR = 1.79，95%CI：1.53 - 2.05，P < 0.01），肠型GC患者5年OS不良（HR = 1.93，95%CI：1.45 - 2.42，P < 0.01）。
结论
高等级肿瘤芽生提示GC或肠型GC患者预后较差。
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