Department of General Surgery, Xinhua Hospital Affiliated to Dalian University, Dalian, PR China.
Department of General Surgery, 967 Hospital of the Joint Service Support Force of PLA, Dalian, PR China.
Medicine (Baltimore). 2022 Jun 24;101(25):e29533. doi: 10.1097/MD.0000000000029533.
The treatment of gastric cancer (GC) with synchronous liver metastasis is still controversial. This systematic review and network meta-analysis was designed to evaluate the long-term outcomes after different treatments of GC with synchronous liver metastasis.
Several electronic databases were searched to identify eligible studies updated on May 1, 2021. Studies assessing the overall survival (OS) after different treatments (including chemotherapy, interventional therapy, surgical therapy alone and adjunctive therapy after surgery) of GC with synchronous liver metastasis were included. Odds ratios with 95% confidence interval (CI) were calculated for survival variables.
A total of 15 studies including 4312 patients were included in this network meta-analysis. Adjunctive therapy after surgery performed better than surgery therapy alone (hazard ratio [HR] = 1.23, 95% credible interval [CrI]: 0.69-2.17), chemotherapy (HR = 1.18, 95%CrI: 0.71-1.95), and interventional therapy in terms of 1-year OS (HR = 2.03, 95%CrI: 1.22-3.37). In terms of 3-OS, adjunctive therapy after surgery showed better efficacy than surgery therapy alone (HR = 1.48, 95%CrI: 0.40-5.47), chemotherapy (HR = 1.27, 95%CrI: 0.37-4.35), and interventional therapy (HR = 3.16, 95%CrI: 0.73-13.63). For 5-OS, adjunctive therapy after surgery was superior to surgery therapy alone (HR = 1.74, 95%CrI: 0.08-37.76), chemotherapy (HR = 1.44, 95%CrI: 0.66-3.14), and interventional therapy (HR = 1.46, 95%CrI: 0.06-34.36). There were no statistical inconsistency and small-study effect existed in our network meta-analysis for 1-year, 3-year, or 5-year OS. Cluster ranking analysis performed with surface under the cumulative ranking showed adjuvant therapies after surgery (99.9, 96.7, 90.2) ranking higher than surgery therapy alone, chemotherapy, and interventional therapy for 1-year, 3-year, 5-year OS.
The OS of adjuvant therapy after surgery was better than that of surgery therapy alone, chemotherapy, and interventional therapy. Adjuvant therapy after surgery is the most recommended therapy for people with GC with synchronous liver metastasis.
胃癌（GC）合并肝转移的治疗仍存在争议。本系统评价和网络荟萃分析旨在评估 GC 合并肝转移不同治疗方法的长期预后。
检索了截至 2021 年 5 月 1 日更新的多个电子数据库，以确定符合条件的研究。纳入评估 GC 合并肝转移不同治疗方法（包括化疗、介入治疗、单纯手术治疗和手术后辅助治疗）后总生存期（OS）的研究。使用优势比（OR）和 95%可信区间（CI）计算生存变量。
本网络荟萃分析共纳入 15 项研究，共计 4312 例患者。手术后辅助治疗在 1 年 OS（OR=1.23，95%CrI：0.69-2.17）、3 年 OS（OR=1.48，95%CrI：0.40-5.47）和 5 年 OS（OR=1.74，95%CrI：0.08-37.76）方面优于单纯手术治疗（HR=1.18，95%CrI：0.71-1.95）、化疗（HR=2.03，95%CrI：1.22-3.37）和介入治疗。与单纯手术治疗相比，手术后辅助治疗在 3 年 OS（HR=1.48，95%CrI：0.40-5.47）、化疗（HR=1.27，95%CrI：0.37-4.35）和介入治疗（HR=3.16，95%CrI：0.73-13.63）方面的 3 年 OS 更好。在 5 年 OS 方面，手术后辅助治疗优于单纯手术治疗（HR=1.44，95%CrI：0.66-3.14）、化疗（HR=1.46，95%CrI：0.06-34.36）和介入治疗（HR=1.46，95%CrI：0.06-34.36）。我们的网络荟萃分析在 1 年、3 年或 5 年 OS 方面没有统计学上的不一致性和小样本效应。累积排序曲线下面积（SUCRA）的聚类排名分析显示，手术后辅助治疗（99.9、96.7、90.2）在 1 年、3 年和 5 年 OS 方面的排名均高于单纯手术治疗、化疗和介入治疗。
手术后辅助治疗的 OS 优于单纯手术治疗、化疗和介入治疗。手术后辅助治疗是 GC 合并肝转移患者最推荐的治疗方法。
