Alberto Aiolfi, Matteo Calì, Francesco Cammarata, Federica Grasso, Gianluca Bonitta, Antonio Biondi, Luigi Bonavina, Davide Bona
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引用次数: 0
摘要
背景：在局部晚期胃癌（LAGC）患者中，与开放式远端胃切除术（ODG）相比，微创远端胃切除术（MIDG）与改善的短期预后相关。MIDG对患者长期生存的影响仍有争议。目的是比较MIDG和ODG对长期生存的影响。方法：随机对照试验（RCTs）的系统评价和试验序列分析（TSA）。Web of Science、Scopus、MEDLINE、Cochrane Central Library和ClinicalTrials.gov被查询。采用风险比（HR）和95%置信区间（CI）作为合并效应大小测量。5年总生存率（OS）和无病生存期（DFS）是主要结局。结果：纳入5项rct（2835例患者）。总体而言，1421例（50.1%）患者接受了MIDG， 1414例（49.9%）患者接受了ODG。年龄在48 ~ 70岁之间，男性占63.4%。合并5年OS (HR = 0.86；95% ci 0.70-1.04；I2 = 0.0%)和5年DFS (HR = 1.03；95% ci 0.87-1.23；I2 = 0.0%)在MIDG和ODG中相似。TSA显示了一个累积的Z曲线，没有越过监测边界线（Z = 1.96），这表明由于总信息量不够，5年OS和DFS结果不确定。结论：在LAGC患者中，MIDG和ODG似乎具有相同的5年OS和DFS。然而，来自运输安全管理局的累积证据表明，实际信息的大小不足以提供结论性数据。
Minimally Invasive Versus Open Distal Gastrectomy for Locally Advanced Gastric Cancer: Trial Sequential Analysis of Randomized Trials.
Background: Minimally invasive distal gastrectomy (MIDG) has been shown to be associated with improved short-term outcomes compared to open distal gastrectomy (ODG) in patients with locally advanced gastric cancer (LAGC). The impact of MIDG on long-term patient survival remains debated. Aim was to compare the MIDG vs. ODG effect on long-term survival.
Methods: Systematic review and trial sequential analysis (TSA) of randomized controlled trials (RCTs). Web of Science, Scopus, MEDLINE, the Cochrane Central Library, and ClinicalTrials.gov were queried. Hazard ratio (HR) and 95% confidence intervals (CI) were used as pooled effect size measures. Five-year overall (OS) and disease-free survival (DFS) were primary outcomes.
Results: Five RCTs were included (2835 patients). Overall, 1421 (50.1%) patients underwent MIDG and 1414 (49.9%) ODG. The ages ranged from 48 to 70 years and 63.4% were males. The pooled 5-year OS (HR = 0.86; 95% CI 0.70-1.04; I2 = 0.0%) and 5-year DFS (HR = 1.03; 95% CI 0.87-1.23; I2 = 0.0%) were similar for MIDG vs. ODG. The TSA shows a cumulative z-curve without crossing the monitoring boundaries line (Z = 1.96), thus suggesting not conclusive 5-year OS and DFS results because the total information size was not sufficient.
Conclusions: MIDG and ODG seem to have equivalent 5-year OS and DFS in patients with LAGC. However, the cumulative evidence derived from the TSA showed that the actual information size is not sufficient to provide conclusive data.
期刊介绍：
Cancers (ISSN 2072-6694) is an international, peer-reviewed open access journal on oncology. It publishes reviews, regular research papers and short communications. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced.
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