早期印戒细胞胃癌的内镜下黏膜下剥离术：一项系统评价和荟萃分析。
Endoscopic submucosal dissection for early signet ring cell gastric cancer: A systematic review and meta-analysis.
作者信息
Weng Chun-Yan, Sun Shao-Peng, Cai Chang, Xu Jing-Li, Lv Bin
机构信息
Department of Gastroenterology, The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China.
Department of Gastrointestinal Surgery, The First Clinical Medical University of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China.
出版信息
World J Clin Cases. 2022 Jul 16;10(20):6915-6926. doi: 10.12998/wjcc.v10.i20.6915.
BACKGROUND
The use of endoscopic submucosal dissection (ESD) for treating early signet ring cell carcinoma (SRC) is controversial due to the risk of lymph node metastasis.
AIM
To carry out a meta-analysis to evaluate ESD for therapeutic efficacy and safety in early signet ring cell gastric cancer.
METHODS
The PubMed, Web of Science, Cochrane Library, and EMBASE databases were used to search for relevant studies evaluating the therapeutic efficacy and safety of ESD in SRC. The rates of recurrence, complete resection, incomplete resection, curative resection, resection, and adverse events were extracted and analyzed. The methodological quality of the enrolled studies was assessed using the Newcastle-Ottawa Scale. Publication bias was evaluated by the Egger's test. Institutional review board approval and written consent were not needed for this report.
RESULTS
This meta-analysis enrolled seven studies with 653 participants undergoing ESD treatment for early SRC. The overall recurrence rate was 0.010 [95% confidence interval (CI): 0.000-0.040, = 1.422, = 0.155]. The total lymphovascular invasion rate was 0.038 (95%CI: 0.007-0.088, = 3.026, = 0.002). The total resection rate was estimated at 0.984 (95%CI: 0.925-1.000, = 19.463, = 0.000). The total complete and incomplete resection rates were estimated at 0.785 (95%CI: 0.596-0.928, = 9.789, = 0.000) and 0.188 (95%CI: 0.016-0.468, = 2.531, = 0.011), respectively. The total procedure-associated gastric hemorrhage and perforation rates were estimated at 0.026 (95%CI: 0.005-0.061, = 3.006 = 0.003) and 0.004 (95%CI: 0.000-0.028, = 0.938, = 0.348), respectively. The curative resection, vertical margin invasion, and lateral margin invasion rates were 72.1% (145/341), 2.3% (8/348), and 34.45% (41/119), respectively.
CONCLUSION
ESD constitutes a promising therapeutic approach for early undifferentiated SRC gastric cancer. However, further improvements are required for increasing its treatment efficacy and reducing adverse outcomes.
背景
由于存在淋巴结转移风险，内镜黏膜下剥离术（ESD）用于治疗早期印戒细胞癌（SRC）存在争议。
目的
进行一项荟萃分析，以评估ESD治疗早期胃印戒细胞癌的疗效和安全性。
方法
使用PubMed、Web of Science、Cochrane图书馆和EMBASE数据库检索评估ESD治疗SRC疗效和安全性的相关研究。提取并分析复发率、完全切除率、不完全切除率、根治性切除率、切除率和不良事件。使用纽卡斯尔-渥太华量表评估纳入研究的方法学质量。通过Egger检验评估发表偏倚。本报告无需机构审查委员会批准和书面同意。
结果
本荟萃分析纳入了7项研究，共653例接受ESD治疗的早期SRC患者。总体复发率为0.010[95%置信区间（CI）：0.000 - 0.040，χ² = 1.422，P = 0.155]。总淋巴管侵犯率为0.038（95%CI：0.007 - 0.088，χ² = 3.026，P = 0.002）。总切除率估计为0.984（95%CI：0.925 - 1.000，χ² = 19.463，P = 0.000）。总完全切除率和不完全切除率分别估计为0.785（95%CI：0.596 - 0.928，χ² = 9.789，P = 0.000）和0.188（95%CI：0.016 - 0.468，χ² = 2.531，P = 0.011）。总手术相关胃出血和穿孔率分别估计为0.026（95%CI：0.005 - 0.061，χ² = 3.006，P = 0.003）和0.004（95%CI：0.000 - 0.028，χ² = 0.938，P = 0.348）。根治性切除率、垂直切缘侵犯率和侧切缘侵犯率分别为72.1%（145/341）、2.3%（8/348）和34.45%（41/119）。
结论
ESD是早期未分化SRC胃癌的一种有前景的治疗方法。然而，需要进一步改进以提高其治疗效果并减少不良后果。
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