肿瘤间质成熟度与结直肠癌预后关系的Meta分析

The relationship between tumor stromal maturity and prognosis of colorectal cancer:a Meta analysis

目的探讨肿瘤间质成熟度与结直肠癌预后的关系。方法检索万方、中国知网、Cochrane Library、PubMed、SpringerLink、EBSCO、MEDLINE等数据库,以“肿瘤间质成熟度”“促纤维间质反应”“促纤维反应”“间质反应”“间质反应程度”“间质分级”“间质密度”“结直肠癌”“预后”“tumor stroma maturity”“desmoplastic stroma reaction”“desmoplastic reaction”“stroma reaction”“degree of stroma reaction”“stroma classification”“stroma density”“colorectal cancer”“colon cancer”“rectal cancer”“prognosis”为检索词检索从建库至2021年1月所有研究肿瘤间质成熟度与结直肠癌预后关系的文献,提取相关临床资料和数据,根据纳入和排除标准,并根据NOS量表评估文献质量,最后采用RevMan5.4及R语言“metafor”包进行Meta分析。结果最终纳入15篇文献共19个队列9849例结直肠癌患者的资料,其中成熟型4339例(对照组),中间型3048例(中间型组),不成熟型2456例(不成熟型组),Meta分析结果显示:不成熟型组患者无复发生存率(HR=2.66,95%CI:2.30~3.08;P<0.00001)、无病生存率(HR=3.68,95%CI:2.33~5.81;P<0.00001)和总生存率(HR=1.70,95%CI:1.53~1.87;P<0.00001)均明显低于成熟型组(对照组);中间型组患者无复发生存率(HR=1.36,95%CI:1.17~1.59;P<0.0001)和无病生存率(HR=1.85,95%CI:1.53~2.24;P<0.0001)亦明显低于成熟型组(对照组)。结论肿瘤间质成熟度与结直肠癌预后密切相关。

Objective To investigate the relationship between tumor stromal maturity and prognosis of colorectal cancer.Methods The literatures researching the relationship between tumor stromal maturity and prognosis of colorectal cancer were searched in the Wangfang,CNKI,CochraneLibrary,PubMed,SpringerLink,EBSCO,MEDLINE and other databases from database construction to January 2021,"tumor stroma maturity""desmoplastic stroma reaction""desmoplastic reaction""stroma reaction""degree of stroma reaction""stroma classification""stroma density""colorectal cancer""colon cancer""rectal cancer""prognosis"were selected as keywords,relevant clinical data were extracted according to the inclusion and exclusion criteria,and the quality of literatures were evaluated according to NOS form,the Meta-analysis was performed by RevMan5.4 and"metafor"R package.Results A total of 15 articles including 9849 colorectal cancer patients in 19 cohorts were analysed in this Meta-analysis.These cohorts were composed by 4339 patients with mature stroma(control group),3048 patients with intermediate stroma(intermediate group)and 2456 patients with immature troma(immature group).The Meta-analysis results showed that there was significant difference between the immature group and control group in recurrence-free survival(HR=2.66,95%CI:2.30~3.08;P<0.00001),disease-free survival(HR=3.68,95%CI:2.33~5.81,P<0.00001)and overall survival(HR=1.70,95%CI:1.53~1.87;P<0.00001);there was also significant difference between the intermediate group and control group in RFS(HR=1.36,95%CI:1.17~1.59,P<0.0001)and DFS(HR=1.85,95%CI:1.53~2.24,P<0.0001).Conclusion The prognosis of colorectal cancer was closely related to the tumor stromal maturity.