手术切除对胃肠胰神经内分泌肿瘤伴肝转移预后影响的Meta分析

Meta-analysis of the prognostic impact of surgical resection of gastroenteropancreatic neuroendocrine tumors with liver metastases

目的探讨手术切除对胃肠胰神经内分泌肿瘤伴肝转移患者预后的影响。方法本研究通过Meta分析,以"胃肠胰神经内分泌肿瘤""肝转移""原发性肿瘤切除术""肝转移灶切除术""原发性灶及肝转移灶切除术"为中文检索关键词,以"Gastroenteropancreatic neuroendocrine tumor""liver metastasis""liver resection""primary tumor resection"为英文检索关键词,设置检索时间为2000年1月1日-2022年7月30日。在知网、Pubmed、Embase和Cochrane library中检索有关胃肠胰神经内分泌肿瘤肝转移的研究。在对纳入研究进行质量评价后,使用Review Manager 5.4.1和STATA 17软件进行荟萃分析。结果符合标准共计16篇文献,系统分析:与非手术治疗相比,手术治疗(原发肿瘤切除术、肝转移灶切除术、原发性肿瘤切除+肝转移灶切除术)患者的病死率明显降低,差异具有统计学意义(P<0.01);对于肝转移灶可切除的患者,单独原发肿瘤切除术与原发肿瘤切除术+肝转移灶切除相比,5年总生存率差异有统计学意义(P<0.01),且其原发肿瘤切除术+肝转移灶切除可使患者中位生存期延长;对于有肝转移的患者,5年生存期与肝转移灶占肝脏体积大小差异有统计学意义(P<0.01),转移灶大于50%预后差。结论手术治疗可明显提高神经内分泌肿瘤伴肝转移患者的生存时间,仅行原发灶切除或转移灶切除,也有效改善患者预后。

ObjectiveTo investigate the effect of surgical resection on the prognosis of patients with gastroenteropancreatic neuroendocrine tumors with liver metastases.MethodsThrough meta-analysis,this study used"Gastroenteropancreatic neuroendocrine tumor""liver metastasis""liver resection"and"primary tumor"."resection"were English keywords,and the search period was from 1 January 2000 to 30 July 2022.CNKI,Pubmed,Embase,and the Cochrane library were searched for studies on liver metastases from gastroenteropancreatic neuroendocrine tumors.After quality evaluation of the included studies,a meta-analysis was performed using Review Manager 5.4.1 and STATA 17 software.ResultsComplying with the standard total of 16 papers,systematic analysis showed that compared with non-surgical treatment,the mortality rate of patients treated surgically(primary tumor resection,liver metastasectomy,primary tumor resection+liver metastasectomy)was significantly lower,and the difference was statistically significant(P<0.01);for patients with resectable liver metastases,primary tumor resection alone versus primary tumor resection+liver metastase for patients with resectable liver metastases,5-year overall survival was statistically significant(P<0.01)compared with primary tumor resection+liver metastases resection,and their primary tumor resection+liver metastases resection prolonged the median survival;for patients with liver metastases,5-year survival was statistically different from the size of liver metastases to liver volume(P<0.01),and metastases greater than 50%had poor prognosis.ConclusionSurgical treatment can significantly improve the survival time of patients with neuroendocrine tumors with liver metastases,and resection of only the primary site or metastases is also effective in improving the prognosis of patients.