原发肿瘤位置对结肠癌根治性切除术后生存的影响：倾向评分匹配研究的荟萃分析。

Impact of Primary Tumor Location on Survival After Curative Resection in Patients with Colon Cancer: A Meta-Analysis of Propensity Score-Matching Studies.

机构信息

Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.

出版信息

Oncologist. 2021 Mar;26(3):196-207. doi: 10.1002/onco.13555. Epub 2020 Oct 21.

DOI:10.1002/onco.13555

PMID:33031622

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7930413/

Abstract

BACKGROUND

Recent retrospective subgroup analyses of patients with unresectable colon cancer (CC) receiving systemic chemotherapy have demonstrated that there is a significant difference in treatment outcome between patients with right-sided CC (RSCC) and those with left-sided CC (LSCC). However, it is impossible to divide patients with CC randomly into RSCC and LSCC groups before surgery. Therefore, the aim of this study is to explore the impact of primary tumor location (PTL) on survival after curative surgery for patients with CC using propensity score-matching (PSM) studies instead of randomization.

MATERIALS AND METHODS

We performed a comprehensive electronic search of the literature up to January 2019 to identify studies that had used databases allowing comparison of postoperative survival between patients with RSCC and those with LSCC. To integrate the impact of PTL on 5-year overall survival (OS) after curative surgery, a meta-analysis was performed using random-effects models to calculate the risk ratio (RR) and 95% confidence interval (CI) for the selected PSM studies.

RESULTS

Five studies involving a total of 398,687 patients with CC were included in this meta-analysis. Among 205,641 patients with RSCC, 69,091 (33.6%) died during the observation period, whereas among 193,046 patients with LSCC, 63,380 (32.8%) died during the same period. These results revealed that patients with RSCC and those with LSCC had almost the same 5-year OS (RR, 0.98; 95% CI, 0.89-1.07; p = .64; I = 97%).

CONCLUSION

This meta-analysis has demonstrated that there was no significant difference in 5-year OS between patients with RSCC and those with LSCC after curative resection.

IMPLICATIONS FOR PRACTICE

To integrate the impact of primary tumor location (PTL) on 5-year overall survival (OS) after curative surgery, five propensity score-matching (PSM) studies involving a total of 398,687 patients with colon cancer (CC) were included in this meta-analysis. Among 205,641 patients with right-sided CC (RSCC), 69,091 (33.6%) died during the observation period, whereas among 193,046 patients with left-sided CC (LSCC), 63,380 (32.8%) died during the same period. These results revealed that patients with RSCC and those with LSCC had almost the same 5-year OS (risk ratio, 0.98; 95% confidence interval, 0.89-1.07; p = .64; I = 97%).

摘要

背景

最近对接受系统化疗的不可切除结肠癌（CC）患者的回顾性亚组分析表明，右侧 CC（RSCC）和左侧 CC（LSCC）患者的治疗结果存在显著差异。然而，在手术前不可能将 CC 患者随机分为 RSCC 和 LSCC 组。因此，本研究旨在使用倾向评分匹配（PSM）研究而非随机分组来探讨原发肿瘤位置（PTL）对 CC 患者根治性手术后生存的影响。

材料和方法

我们对截至 2019 年 1 月的文献进行了全面的电子检索，以确定使用允许比较 RSCC 患者和 LSCC 患者术后生存情况的数据库的研究。为了综合 PTL 对根治性手术后 5 年总生存率（OS）的影响，我们使用随机效应模型进行荟萃分析，以计算选定 PSM 研究的风险比（RR）和 95%置信区间（CI）。

结果

本荟萃分析纳入了 5 项共涉及 398687 例 CC 患者的研究。在 205641 例 RSCC 患者中，有 69091 例（33.6%）在观察期间死亡，而在 193046 例 LSCC 患者中，有 63380 例（32.8%）在同一时期死亡。这些结果表明，RSCC 患者和 LSCC 患者的 5 年 OS 几乎相同（RR，0.98；95%CI，0.89-1.07；p =.64；I = 97%）。

结论

本荟萃分析表明，根治性切除术后 RSCC 患者和 LSCC 患者的 5 年 OS 无显著差异。

意义

为了综合 PTL 对根治性手术后 5 年 OS 的影响，本荟萃分析纳入了 5 项共涉及 398687 例 CC 患者的 PSM 研究。在 205641 例 RSCC 患者中，有 69091 例（33.6%）在观察期间死亡，而在 193046 例 LSCC 患者中，有 63380 例（32.8%）在同一时期死亡。这些结果表明，RSCC 患者和 LSCC 患者的 5 年 OS 几乎相同（RR，0.98；95%CI，0.89-1.07；p =.64；I = 97%）。