错配修复缺陷或微卫星不稳定型胃癌患者的辅助化疗：系统评价和荟萃分析。
Adjuvant Chemotherapy for Gastric Cancer Patients with Mismatch Repair Deficiency or Microsatellite Instability: Systematic Review and Meta-Analysis.
机构信息
Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
出版信息
Ann Surg Oncol. 2022 Apr;29(4):2324-2331. doi: 10.1245/s10434-021-11050-6. Epub 2021 Nov 18.
BACKGROUND
Mismatch repair-deficient (dMMR) or microsatellite instability-high (MSI-H) status serves as a predictor of a poor response to adjuvant chemotherapy among stage 2 colon cancer patients. This study aimed to investigate the efficacy of adjuvant chemotherapy in dMMR/MSI-H gastric cancer (GC).
METHODS
Clinical studies comparing adjuvant chemotherapy and surgery alone in dMMR/MSI-H GCs through June 2021 were retrieved to assess the survival of patients managed with both treatments. Two approaches were used to pool the hazard ratio (HR) of survival: (1) if Kaplan-Meier curves and number of patients at risk were provided, individual patient data were extracted. Cox models were used to calculate the HR with its 95% confidence interval (CI); (2) for study-level data, pooled HR was estimated using fixed/random-effects models.
RESULTS
Seven clinical studies were assessed. For dMMR/MSI-H versus mismatch repair-proficient (pMMR)/microsatellite stable (MSS)/microsatellite instability-low (MSI-L) status, the estimated 5-year disease-free survival (DFS) rate was 74.2% versus 51.5% (HR, 0.44; 95% CI, 0.32-0.62; P < 0.001) and the estimated 5-year OS rate was 60.5% versus 49.1% (HR, 0.71; 95% CI, 0.60-0.85; P < 0.001). The study-level data showed pooled HRs of 0.42 for DFS (95% CI, 0.31-0.57; P < 0.001) and 0.65 for OS (95% CI, 0.38-1.11; P = 0.114). For adjuvant chemotherapy versus observation of dMMR/MSI-H, the estimated 5-year DFS rate was 76.1% versus 73.3% (HR, 0.72; 95% CI, 0.45-1.15; P = 0.171) and the estimated 5-year OS rate was 73.5% versus 59.7% (HR, 0.62; 95% CI, 0.46-0.83; P = 0.001). Significant survival differences also were observed at study level.
CONCLUSIONS
The study findings confirm the benefit of adjuvant chemotherapy for dMMR/MSI-H GC patients.
背景
错配修复缺陷（dMMR）或微卫星不稳定性高（MSI-H）状态可作为预测 II 期结直肠癌患者对辅助化疗反应不良的指标。本研究旨在探讨辅助化疗在 dMMR/MSI-H 胃癌（GC）中的疗效。
方法
检索截至 2021 年 6 月比较 dMMR/MSI-H GC 患者接受辅助化疗与单纯手术的临床研究，评估接受两种治疗方法患者的生存情况。采用两种方法汇总生存的风险比（HR）：（1）如果提供了 Kaplan-Meier 曲线和患者风险人数，则提取个体患者数据。使用 Cox 模型计算 HR 及其 95%置信区间（CI）；（2）对于研究水平的数据，使用固定/随机效应模型估计汇总 HR。
结果
评估了 7 项临床研究。对于 dMMR/MSI-H 与错配修复功能正常（pMMR）/微卫星稳定（MSS）/微卫星不稳定性低（MSI-L）状态，估计的 5 年无病生存率（DFS）分别为 74.2%和 51.5%（HR，0.44；95%CI，0.32-0.62；P<0.001），估计的 5 年总生存率（OS）分别为 60.5%和 49.1%（HR，0.71；95%CI，0.60-0.85；P<0.001）。研究水平的数据显示 DFS 的汇总 HR 为 0.42（95%CI，0.31-0.57；P<0.001），OS 的汇总 HR 为 0.65（95%CI，0.38-1.11；P=0.114）。对于 dMMR/MSI-H 的辅助化疗与观察，估计的 5 年 DFS 率分别为 76.1%和 73.3%（HR，0.72；95%CI，0.45-1.15；P=0.171），估计的 5 年 OS 率分别为 73.5%和 59.7%（HR，0.62；95%CI，0.46-0.83；P=0.001）。在研究水平上也观察到显著的生存差异。
结论
研究结果证实了辅助化疗对 dMMR/MSI-H GC 患者的益处。
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