姑息性胃切除术在不可治愈的晚期胃癌中的预后意义：一项回顾性队列研究和荟萃分析

Prognostic significance of palliative gastrectomy in incurable advanced gastric cancer: a retrospective cohort study and meta-analysis.

作者信息

Zheng C, Gao Z-M, Huang H-B, Li K, Liu X-F

机构信息

Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Cahina.

出版信息

Eur Rev Med Pharmacol Sci. 2021 Mar;25(5):2299-2312. doi: 10.26355/eurrev_202103_25262.

DOI:10.26355/eurrev_202103_25262

PMID:33755967

Abstract

OBJECTIVE

There is controversy regarding the role of palliative gastrectomy in patients with incurable advanced gastric cancer requiring surgical intervention. The present retrospective cohort study and meta-analysis aimed to determine whether palliative gastrectomy plus chemotherapy can prolong the survival of patients with incurable advanced gastric cancer requiring surgical intervention.

PATIENTS AND METHODS

The data from 153 patients diagnosed with incurable advanced gastric cancer requiring surgical intervention at our institute between January 2000 and December 2012 were retrospectively reviewed. We analyzed the value of palliative gastrectomy and identified the potential prognostic factors. We also conducted a meta-analysis of 10 studies to validate our results.

RESULTS

Multivariate analysis indicated that palliative gastrectomy was a favorable independent prognostic factor for prolonged overall survival in incurable advanced gastric cancer patients requiring surgical intervention (p=0.029). The median survival of patients who underwent palliative gastrectomy plus chemotherapy was significantly longer than that of those who underwent non-resection surgery plus chemotherapy (12 months vs. 9 months, p=0.020). The patients in the non-resection surgery plus chemotherapy group exhibited significantly shorter overall survival than those in the D1+ lymphadenectomy group, D2 lymphadenectomy group, or distal gastrectomy group (p=0.021, p=0.007, and p=0.006, respectively). Our meta-analysis revealed that gastrectomy plus chemotherapy improved long-term survival in incurable advanced gastric cancer patients (hazard ratio (HR): 0.48; 95% confidence interval (CI): 0.35-0.67; p<0.001).

CONCLUSIONS

Palliative gastrectomy plus chemotherapy may improve overall patient survival compared with non-resection operations plus chemotherapy in incurable advanced gastric cancer patients requiring surgical intervention.

摘要

目的

对于姑息性胃切除术在需要手术干预的无法治愈的晚期胃癌患者中的作用存在争议。本回顾性队列研究和荟萃分析旨在确定姑息性胃切除术联合化疗是否能延长需要手术干预的无法治愈的晚期胃癌患者的生存期。

患者与方法

回顾性分析了2000年1月至2012年12月间在我院诊断为需要手术干预的无法治愈的晚期胃癌的153例患者的数据。我们分析了姑息性胃切除术的价值并确定了潜在的预后因素。我们还对10项研究进行了荟萃分析以验证我们的结果。

结果

多变量分析表明，姑息性胃切除术是需要手术干预的无法治愈的晚期胃癌患者延长总生存期的有利独立预后因素（p = 0.029）。接受姑息性胃切除术联合化疗的患者的中位生存期明显长于接受非切除手术联合化疗的患者（12个月对9个月，p = 0.020）。非切除手术联合化疗组患者的总生存期明显短于D1 +淋巴结清扫组、D2淋巴结清扫组或远端胃切除术组的患者（分别为p = 0.021、p = 0.007和p = 0.006）。我们的荟萃分析显示，胃切除术联合化疗可改善无法治愈的晚期胃癌患者的长期生存（风险比（HR）：0.48；95%置信区间（CI）：0.35 - 0.67；p < 0.001）。