内镜黏膜下剥离术与手术治疗浅表性食管鳞状细胞癌的系统评价和Meta分析
Endoscopic Submucosal Dissection vs. Surgery for Superficial Esophageal Squamous Cancer: A Systematic Review and Meta-Analysis.
作者信息
Liu Zhifeng, Zhao Renping
机构信息
Department of Gastroenterology, the Third People's Hospital of Hubei Province, Jianghan University, Wuhan, China.
Department of Radiology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
出版信息
Front Oncol. 2022 Apr 21;12:816832. doi: 10.3389/fonc.2022.816832. eCollection 2022.
BACKGROUND
Esophageal cancer is one of the leading causes of morbidity and mortality across the world. Only one systematic review and meta-analysis has attempted to compare the morbidity and mortality outcomes in superficial esophageal squamous cancer patients undergoing endoscopic submucosal dissection (ESD) and esophagectomy (ESO), but with several limitations. This study aimed at comparing the outcomes of hospital stay duration, procedure duration, recurrence, complications, all-cause mortality, short-term survival, and long-term survival in patients with superficial esophageal squamous cancer undergoing ESD and ESO.
METHODS
Six databases (Web of Science, PubMed, EMBASE, CENTRAL, Scopus, and MEDLINE) were systematically searched according to PRISMA guidelines for eligible studies. With the available literature, we conducted a random-effect meta-analysis to evaluate weighted effect size and odds ratios to determine the comparative morbidity and mortality outcomes between patients with superficial esophageal squamous cancer undergoing ESD and ESO.
RESULTS
We found 16 eligible studies detailing 5,213 and 8,049 age- and sex-matched patients undergoing ESD and ESO, respectively. Meta-analysis revealed reduced hospital stay (Hedge's g: -1.22) and procedure duration (g: -4.54) for patients undergoing ESD. We also observed significantly reduced risks for complications (odds ratio: 0.35) and all-cause mortality (OR: 0.56) in patients undergoing ESD. Differences in recurrence (OR: 0.95), short-term outcomes (OR: 1.10), and long-term survival (OR: 0.81) outcomes were not significantly different between ESD and ESO.
CONCLUSIONS
This meta-analysis provides evidence concerning the improved morbidity and mortality outcomes in superficial esophageal squamous cancer patients undergoing ESD as compared to ESO. The findings herein may aid in developing clinical awareness and assisting best practice guideline development for managing superficial esophageal squamous cancer.
REGISTRATION
PROSPERO, https://www.crd.york.ac.uk/prospero/#searchadvanced, CRD42021286212.
背景
食管癌是全球发病和死亡的主要原因之一。仅有一项系统评价和荟萃分析试图比较接受内镜黏膜下剥离术（ESD）和食管切除术（ESO）的浅表食管鳞状细胞癌患者的发病和死亡结局，但存在若干局限性。本研究旨在比较接受ESD和ESO的浅表食管鳞状细胞癌患者的住院时间、手术时间、复发、并发症、全因死亡率、短期生存和长期生存结局。
方法
根据PRISMA指南，系统检索了六个数据库（Web of Science、PubMed、EMBASE、CENTRAL、Scopus和MEDLINE）以查找符合条件的研究。利用现有文献，我们进行了随机效应荟萃分析，以评估加权效应大小和比值比，以确定接受ESD和ESO的浅表食管鳞状细胞癌患者之间的比较发病和死亡结局。
结果
我们发现16项符合条件的研究，分别详细描述了5213例和8049例年龄和性别匹配的接受ESD和ESO的患者。荟萃分析显示，接受ESD的患者住院时间缩短（Hedge's g：-1.22）和手术时间缩短（g：-4.54）。我们还观察到接受ESD的患者并发症风险（比值比：0.35）和全因死亡率（OR：0.56）显著降低。ESD和ESO在复发（OR：0.95）、短期结局（OR：1.10）和长期生存（OR：0.81）结局方面的差异无统计学意义。
结论
这项荟萃分析提供了证据，表明与ESO相比，接受ESD的浅表食管鳞状细胞癌患者的发病和死亡结局有所改善。本文的研究结果可能有助于提高临床认识，并协助制定管理浅表食管鳞状细胞癌的最佳实践指南。
注册信息
PROSPERO，https://www.crd.york.ac.uk/prospero/#searchadvanced，CRD42021286212
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