应用减量手术治疗无症状不可切除性晚期胃癌疗效Meta分析

Meta-analysis of the efficacy of reduction surgery in incurable asymptomatic advanced gastric cancer

目的系统性评价减量手术在无症状不可切除性晚期胃癌中的有效性及安全性。方法对PubMed、Cochrane图书馆、中国知网与万方数据库相关研究进行检索及筛选,检索期限为从建库至2021-05-12。纳入比较无症状的不可切除性晚期胃癌病人初始行原发灶切除或初始行全身治疗的研究。结果最终共5项研究,其中包括随机对照研究1篇,回顾性研究4篇。累计样本量1717例,其中减量手术组共701例,非手术治疗组共1016例。Meta分析结果显示:减量手术组在1年、3年、5年生存率方面,相较非手术治疗组,均不能带来生存获益;在中位生存时间方面,减量手术组相较非手术治疗组长11.58个月;减量手术组围术期并发症发生率、病死率分别为15%、4%;约有3%的病人在非手术治疗过程中可能会出现原发灶并发症而需进行姑息性手术切除。结论当前证据显示对于无症状的不可切除性晚期胃癌病人,原发灶切除的减量手术并不能获得生存获益。期待更多的高质量随机对照研究为临床实践提供更有力的证据支持。

Objective To evaluate the efficacy and safety of reduction surgery in incurable, asymptomatic advanced gastric cancer.Methods A literature search was conducted in PubMed, the Cochrane Library, Chinese National Knowledge Infrastructure and WanFang databases to identify studies comparing reduction surgery and systemic treatment for incurable asymptomatic advanced gastric cancer until 12 May 2021.Results A total of 5 original studies(RCT:1;cohort study:4) were included in this analysis with a total of 1717 patients(reduction surgery: 701 cases,systemic treatment: 1016 cases). The results showed that there were no significant differences in 1-year overall survival,3-year overall survival and 5-year overall survival. The median survival time of reduction surgery group was 11.58 months longer than that of systemic treatment group. The incidence of perioperative complications and mortality in the reduction surgery group were 15% and 4% respectively, about 3% of the patients may need palliative surgery during systemic treatment.Conclusion The current evidence shows no survival benefits from reduction surgery for incurable asymptomatic advanced gastric cancer. More randomized controlled trails are expected to provide evidence support for clinical practice.