Wu Jiaheng, Du Xuetian, He Yiqiang, Xian Shulin
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Department of Gastrointestinal Surgery, Guangxi Nationalities Hospital, Guangxi, China.
BMC Gastroenterol. 2025 May 14;25(1):371. doi: 10.1186/s12876-025-03969-x.
Advanced gastric cancer (AGC) with unresectable factors presents a significant treatment challenge. Conventional treatments such as systemic chemotherapy, radiotherapy, and immunotherapy can delay disease progression but often yield limited outcomes. For stage III-IV gastric cancer with unresectable factors, conversion therapy based on chemotherapy can achieve tumor downstaging, providing a subset of patients with the opportunity for curative surgery. However, the efficacy of multimodal approaches combining chemotherapy, with or without immunotherapy, and conversion surgery compared to chemotherapy alone remains controversial.
We conducted a systematic review and meta-analysis of high-quality studies published between January 2014 and November 2024, assessing the role of surgery following conversion therapy in advanced gastric cancer. Relevant studies were retrieved from PubMed, Embase, and Web of Science databases. All included studies were observational; no randomized trials were available. Clinical data, including overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and adverse event (AE) rates, were analyzed using RevMan 5.4.
Twelve observational cohort studies were included. Conversion surgery(CS) was associated with improved 1-year, 3-year, and 5-year OS rates (RR 0.38, 95% CI: 0.31-0.47; RR 0.64, 95% CI: 0.54-0.76; RR 0.77, 95% CI: 0.65-0.91, respectively) and increased 1-year and 3-year PFS rates (RR 0.57, 95% CI: 0.49-0.99; RR 0.67, 95% CI: 0.57-0.78, respectively). No significant difference in AE rates was observed between groups.
Conversion surgery following chemotherapy in stage III-IV gastric cancer is associated with improved OS and PFS in observational studies. However, these findings may reflect inherent prognostic differences between groups, as surgery was only feasible for chemotherapy responders. Prospective trials are needed to validate causality.
伴有不可切除因素的晚期胃癌（AGC）是一个重大的治疗挑战。全身化疗、放疗和免疫治疗等传统治疗方法虽能延缓疾病进展，但往往疗效有限。对于伴有不可切除因素的III-IV期胃癌，基于化疗的转化治疗可实现肿瘤降期，为一部分患者提供根治性手术的机会。然而，与单纯化疗相比，联合化疗（无论是否联合免疫治疗）和转化手术的多模式治疗方法的疗效仍存在争议。
我们对2014年1月至2024年11月发表的高质量研究进行了系统评价和荟萃分析，评估转化治疗后手术在晚期胃癌中的作用。相关研究从PubMed、Embase和Web of Science数据库中检索。所有纳入研究均为观察性研究；无随机试验可用。使用RevMan 5.4分析临床数据，包括总生存期（OS）、无进展生存期（PFS）、客观缓解率（ORR）和不良事件（AE）发生率。
纳入12项观察性队列研究。转化手术（CS）与1年、3年和5年OS率提高相关（RR分别为0.38，95%CI：0.31-0.47；RR 0.64，95%CI：0.54-0.76；RR 0.77，95%CI：0.65-0.91），且1年和3年PFS率增加（RR分别为0.57，95%CI：0.49-0.99；RR 0.67，95%CI：0.57-0.78）。组间AE发生率无显著差异。
在观察性研究中，III-IV期胃癌化疗后进行转化手术与OS和PFS改善相关。然而，这些发现可能反映了组间固有的预后差异，因为手术仅对化疗反应者可行。需要进行前瞻性试验来验证因果关系。
