中国循证医学杂志

中国循证医学杂志

淋巴结外软组织阳性对胃癌、食管癌和胃食管结合部癌预后影响的 Meta 分析

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目的 系统评价淋巴结外软组织阳性对胃癌、食管癌和胃食管结合部癌预后的影响。 方法 计算机检索 EMbase、The Cochrane Library(2016 年 9 期)、PubMed、CBM、CNKI、VIP 和 WanFang Data 数据库,搜集淋巴结外软组织阳性对胃癌、食管癌及胃食管结合部癌预后相关的队列研究,检索年限均从建库至 2016 年 8 月。由两位研究者独立筛选文献,提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.2 软件进行统计分析。 结果 共纳入 16 个研究,共 9 445 例患者。Meta 分析结果显示:胃癌患者中,淋巴结外软组织阳性患者的术后总体生存期 [HR=1.71,95%CI(1.42,2.04),P<0.000 01],无病生存期 [HR=1.39,95%CI(1.12,1.73),P=0.003] 和癌症特定生存期 [HR=1.52,95%CI(1.18,1.96),P=0.001] 均明显短于阴性组,其差异具有统计学意义。食管癌与胃食管连接部癌患者中,淋巴结外软组织阳性患者的术后总体生存期 [HR=1.84,95%CI(1.49,2.27),P<0.000 01],无病生存期 [HR=2.18,95%CI(1.70,2.81),P<0.000 01] 和癌症特定生存期 [HR=1.73,95%CI(1.19,2.52),P=0.004] 均明显短于阴性组,其差异具有统计学意义。 结论 胃癌、食管癌和胃食管结合部癌中淋巴结外软组织阳性患者比阴性患者预后差。受纳入研究数量和质量限制,上述结论仍需高质量研究加以验证。

Objective To systematically review the prognostic significance of extranodal extension in gastric cancer, esophageal cancer and gastroesophageal junction cancer. Methods We searched EMbase, The Cochrane Library (Issue 9, 2016), PubMed, CBM, CNKI, VIP and WanFang Data databases from inception to August 2016, to collect cohort studies about the prognostic significance of extranodal extension. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.2 software. Results A total of 16 studies involving 9 445 participants were included. The results of meta-analysis showed that for gastric cancer patients, the overall survival (OS) (HR=1.71, 95%CI 1.49 to 2.00,P<0.000 01), disease free survival (DFS) (HR=1.39, 95%CI 1.12 to 1.73,P=0.003) and cancer specific survival (HR=1.52, 95%CI 1.18 to 1.96,P=0.001) in ENE(+) group were lower than ENE(–) group. For esophageal cancer and gastroesophageal junction cancer patients, the overall survival (OS) (HR=1.84, 95%CI 1.49 to 2.27,P<0.000 01), disease free survival (DFS) (HR=2.18, 95%CI 1.70 to 2.81,P<0.000 01) and cancer specific survival (HR=1.73, 95%CI 1.19 to 2.52,P=0.004) in ENE(+) group were lower than ENE(–) group. Conclusion Current evidence indicates that ENE(+) was correlated with a poor prognosis in gastric cancer, esophageal cancer and gastroesophageal junction cancer patients. Due to the quantity and quality limitations of included studies, more high quality cohort studies are needed to verify the above conclusions.

关键词: 胃癌; 食管癌; 胃食管结合部癌; 淋巴结外软组织阳性; 预后; Meta 分析

Key words: Gastric cancer; Esophageal cancer; Gastroesophageal cancer; Extranodal extension; Prognosis; Meta-analysis

引用本文: 雷玉莹, 赵琼蕊, 孙哲. 淋巴结外软组织阳性对胃癌、食管癌和胃食管结合部癌预后影响的 Meta 分析. 中国循证医学杂志, 2017, 17(4): 402-408. doi: 10.7507/1672-2531.201609069 复制

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