Almayouf Furat
Department of Laboratory and Blood Bank, Histopathology Section, Qassim Health Cluster, King Fahad Specialist Hospital, Buraydah, SAU.
Cureus. 2024 Sep 29;16(9):e70422. doi: 10.7759/cureus.70422. eCollection 2024 Sep.
Gastrointestinal (GI) carcinomas represent a heterogeneous composition of malignancies that stem from the organs of the GI tract. They are among the most prevalent and are associated with high mortality alongside morbidity rates. This study utilized the guidelines set forth by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), whereby four medical databases were searched for relevant scholarly publications published between 2010 and 2024. These databases were PubMed, Web of Science, and ScienceDirect. Risk of bias (RoB) for cohort, case-controlled, and cross-sectional studies was assessed using the Newcastle-Ottawa Scale (NOS), whereas randomized controlled trials (RCTs) used the Cochrane (RoB) tool. With the assumption that the observed estimate of the treatment effect differs between the included studies, a random effect meta-analysis was carried out. In the meta-analysis, fifteen trials with 7607 patients were considered. The findings indicate a substantial correlation between high-grade tumor budding and tumor stage, (χ²=480472.97, P<0.00001) with a mean difference of -6.18 at 95% confidence interval (95% CI) (-14.66 to 2.30), tumor differentiation (χ²=23.31, P<0.00001) with a mean difference of -12.60 at 95% CI (-35.89 to 10.68), lymph vascular invasion (χ²=29.59, P<0.00001) with a mean difference of -5.03 at 95% CI (-11.26 to 1.21), and lymph node metastasis (χ²=158.30, P<0.00001) with a mean difference of -3.44 at 95% CI (-4.72, -1.78). Furthermore, in upper gastrointestinal (UGI) patients, high-grade tumor budding was associated with a negative five-year overall survival (P<0.00001) and a mean difference of -0.09 at 95% CI (-0.20 to 0.02). In regards to the risk of bias, most of the retrospective, prospective, case-control, and cohort studies 10/14 were of satisfactory quality. Moreover, 5/7 of the clinical trials had a low risk of bias. However, the funnel plot indicated that there is a probability of publication bias in favor of tumor budding. The study revealed a significant link between tumor budding and key prognostic factors-overall survival, lymph node metastasis, tumor differentiation, and lymphovascular invasion-in upper gastrointestinal carcinomas. High-grade tumor budding is associated with poor clinicopathological characteristics and a five-year overall survival. Tumor budding may serve as a unique prognostic marker. To confirm these results, further research with larger preoperative UGI biopsies is recommended.
胃肠道（GI）癌是源于胃肠道器官的多种恶性肿瘤的统称。它们是最常见的癌症类型之一，死亡率和发病率都很高。本研究采用系统评价和Meta分析的首选报告项目（PRISMA）指南，在四个医学数据库中检索了2010年至2024年间发表的相关学术出版物。这些数据库是PubMed、科学网和ScienceDirect。使用纽卡斯尔-渥太华量表（NOS）评估队列研究、病例对照研究和横断面研究的偏倚风险（RoB），而随机对照试验（RCT）则使用Cochrane（RoB）工具。假设纳入研究中观察到的治疗效果估计值存在差异，进行了随机效应Meta分析。在Meta分析中，纳入了15项试验，共7607名患者。研究结果表明，高级别肿瘤芽生与肿瘤分期之间存在显著相关性（χ²=480472.97，P<0.00001），95%置信区间（95%CI）为-6.18（-14.66至2.30）；与肿瘤分化之间存在显著相关性（χ²=23.31，P<0.00001），95%CI为-12.60（-35.89至10.68）；与淋巴管侵犯之间存在显著相关性（χ²=29.59，P<0.00001），95%CI为-5.03（-11.26至1.21）；与淋巴结转移之间存在显著相关性（χ²=158.30，P<0.00001），95%CI为-3.44（-4.72，-1.78）。此外，在上消化道（UGI）患者中，高级别肿瘤芽生与五年总生存率呈负相关（P<0.00001），95%CI为-0.09（-0.20至0.02）。关于偏倚风险，大多数回顾性、前瞻性、病例对照和队列研究（10/14）质量令人满意。此外，5/7的临床试验偏倚风险较低。然而，漏斗图表明存在有利于肿瘤芽生的发表偏倚可能性。该研究揭示了上消化道癌中肿瘤芽生与关键预后因素（总生存率、淋巴结转移、肿瘤分化和淋巴管侵犯）之间的显著联系。高级别肿瘤芽生与不良的临床病理特征和五年总生存率相关。肿瘤芽生可能是一种独特的预后标志物。为了证实这些结果，建议进行更大规模的术前UGI活检的进一步研究。
