胃癌肝转移患者行肝切除术对远期生存率影响的系统评价

Influence of Surgical Resection for Hepatic Metastases from Gastric Cancer:A Systematic Review

目的系统评价肝切除术治疗胃癌肝转移患者的术后并发症、死亡率、远期生存率。方法计算机检索EMbase、Pub Med、Web of Science、The Cochrane Library(2015年2期)、CBM、Wan Fang Data和CNKI数据库,查找关于肝切除术治疗胃癌肝转移的相关临床研究,检索时限均从建库至2016年5月30日。由2位评价员按纳入与排除标准独立筛选文献、提取资料并评价偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果纳入39个研究进行定性分析,样本中位数为21例,术后30天并发症发生率中位数为24%,术后30天死亡率中位数为0%。术后1、3、5年中位生存率分别为68%、31%和27%。8个队列研究的Meta分析结果显示,与姑息性治疗方法相比,肝切除术治疗胃癌肝转移患者在术后1年和2年死亡率方面,差异有统计学意义[RR=0.47,95%CI(0.38,0.58),P<0.000 01;RR=0.70,95%CI(0.63,0.79),P<0.000 01]。结论现有证据表明,胃癌肝转移患者可从肝切除术中获益。受纳入研究数量和质量所限,上述结论可能存在偏倚,需开展更多高质量研究予以验证。

Objective To examine long-term survival, morbidity, and mortality following hepatic resection for gastric cancer hepatic metastases and to identify prognostic factors that affect survival. Methods A systematic literature search of EMbase, PubMed, Web of Science, The Cochrane Library （Issue 2, 2015）, CBM, WanFang Data, and CNKI was undertaken for studies that evaluated the role of hepatic resection for gastric cancer hepatic metastases. Two reviewers independently screened studies based on inclusion and exclusion criteria, extracted data, and evaluated risk of bias of included studies. RevMan 5.3 software was used for meta-analysis. Results Thirty-nine studies were included, of which, eight studies were included in meta-analysis. The median sample size was 21 （range 10 to 64）. Procedures were associated with a median 30-day morbidity of 24% （0% to 47%） and mortality of 0% （0% to 30%）. The median l-year, 3-year, and 5-year survival rates were 68%, 31%, and 27%, respectively. Meta-analysis result of 8 cohort studies showed hepatic resection of hepatic metastases was associated with a significantly improved overall survival at 1-year and 2-year follow-up （RR=0.47, 95%CI 0.3 to 0.58, P〈0.000 01; RR=0.70, 95%CI 0.63 to 0.79, P〈0.000 01）. Conclusions Patients with hepatic metastasis from gastric cancer may benefit from hepatic resection. More trials are needed to confirm this finding because of the limited included studies and their low quality.