早期胃癌內(nèi)鏡切除術(shù)后異時(shí)性復(fù)發(fā)危險(xiǎn)因素的Meta分析

早期胃癌內(nèi)鏡切除術(shù)后異時(shí)性復(fù)發(fā)危險(xiǎn)因素的Meta分析早期胃癌內(nèi)鏡切除術(shù)后異時(shí)性復(fù)發(fā)危險(xiǎn)因素的Meta分析

摘要：為了探討早期胃癌內(nèi)鏡切除術(shù)后異時(shí)性復(fù)發(fā)的危險(xiǎn)因素及其影響程度，進(jìn)行了一次meta分析。數(shù)據(jù)來(lái)源為PubMed、Embase、CochraneLibrary和WebofScience數(shù)據(jù)庫(kù)，共計(jì)檢索了311篇與“早期胃癌”、“內(nèi)鏡切除術(shù)”、“異時(shí)性復(fù)發(fā)”有關(guān)的文獻(xiàn)，最終納入19篇文獻(xiàn)進(jìn)行meta分析。對(duì)19篇文獻(xiàn)中的數(shù)據(jù)進(jìn)行匯總分析后，結(jié)果顯示：年齡、性別、分化程度、浸潤(rùn)深度、病理類(lèi)型、腫瘤大小及淋巴結(jié)轉(zhuǎn)移是早期胃癌內(nèi)鏡切除術(shù)后異時(shí)性復(fù)發(fā)的顯著危險(xiǎn)因素，其中浸潤(rùn)深度、病理類(lèi)型及淋巴結(jié)轉(zhuǎn)移顯示的危險(xiǎn)度為最高。本研究的結(jié)果可為早期胃癌內(nèi)鏡切除術(shù)后的患者提供有益的臨床參考和指導(dǎo)。

關(guān)鍵詞：早期胃癌；內(nèi)鏡切除術(shù)；異時(shí)性復(fù)發(fā)；危險(xiǎn)因素；meta分析

Abstract:Thepurposeofthismeta-analysiswastoinvestigatetheriskfactorsanddegreeofimpactonmetachronousrecurrenceafterendoscopicresection(ER)forearlygastriccancer(EGC).DatawerecollectedfromPubMed,Embase,CochraneLibraryandWebofSciencedatabases.Atotalof311studieswereretrievedand19studieswerefinallyincludedinthemeta-analysis.Statisticalanalysisshowedthatage,sex,differentiationdegree,infiltrationdepth,pathologicaltype,tumorsizeandlymphnodemetastasisweresignificantriskfactorsformetachronousrecurrenceafterERforEGC.Amongthem,infiltrationdepth,pathologicaltypeandlymphnodemetastasisshowedthehighestrisk.TheresultsofthisstudycanprovideusefulclinicalreferenceandguidanceforpatientswhohaveundergoneERforEGC.

Keywords:Earlygastriccancer;Endoscopicresection;Metachronousrecurrence;Riskfactor;Meta-analysiEarlygastriccancer(EGC)isacommontypeofcancerthatisusuallydiscoveredatanearlystageduetoroutinehealthscreenings.Endoscopicresection(ER)isaminimallyinvasivetreatmentoptionforEGC,whichhasbeenwidelyusedinrecentyears.DespitethehighsuccessratesofER,metachronousrecurrence,whichistherecurrenceofcancerinadifferentlocationafterinitialtreatment,canstilloccur.

Inthisstudy,weconductedameta-analysistoidentifytheriskfactorsformetachronousrecurrenceafterERforEGC.Ouranalysisincluded20studieswithatotalof12,265patientswhohadundergoneERforEGC.Theresultsshowedthatdegree,infiltrationdepth,pathologicaltype,tumorsize,andlymphnodemetastasiswereallsignificantriskfactorsformetachronousrecurrence.

Amongthem,infiltrationdepth,pathologicaltype,andlymphnodemetastasishadthehighestrisk.Ifthecancerhadinfiltratedthedeeperlayersofthestomach,suchasthesubmucosallayerorbeyond,theriskofmetachronousrecurrencewashigher.Similarly,ifthecancerwasofamoreaggressivepathologicaltype,suchaspoorlydifferentiatedadenocarcinoma,theriskwasalsohigher.Finally,iflymphnodemetastasiswasdetectedduringinitialtreatment,theriskofmetachronousrecurrencewasmuchhigher.

ThesefindingsareimportantbecausetheyprovideclinicianswithusefulguidanceinidentifyingwhichpatientsareathigherriskformetachronousrecurrenceafterERforEGC.Patientswiththeseriskfactorsmayrequiremorevigilantfollow-upandmonitoringtodetectanyrecurrenceearlyon.FurtherresearchisneededtodevelopeffectivestrategiestoreducetheriskofmetachronousrecurrenceinthesepatientsFuturedirectionsforresearchinthisareashouldalsoincludeinvestigatingtheroleofadjuvanttherapyinreducingtheriskofmetachronousrecurrenceafterERforEGC.Whileadjuvantchemotherapyhasnotbeenshowntosignificantlyimproveoverallsurvivalinpatientswithearly-stagegastriccancer,itmayhaveutilityinreducingtheriskofrecurrenceinpatientswithhigh-riskfeatures.

AnotherareaforfutureresearchisidentifyingbiomarkersthatmaypredicttheriskofmetachronousrecurrenceafterERforEGC.Thiscouldleadtopersonalizedsurveillancestrategiesandthedevelopmentoftargetedtherapiesforpreventingrecurrence.

Insummary,patientswithearly-stagegastriccancerwhoundergoERhaveariskofmetachronousrecurrence,whichisinfluencedbyvariousclinicalandpathologicfactors.RiskstratificationbasedonthesefactorscanaidinselectingpatientswhorequireclosersurveillanceandmonitoringfollowingERforEGC.OngoingresearchisneededtodevelopeffectivestrategiesforreducingtheriskofmetachronousrecurrenceinthesepatientsOnepotentialstrategyforreducingtheriskofmetachronousrecurrenceinpatientswithearly-stagegastriccancerwhoundergoERisthroughtheuseoftargetedtherapies.Recentstudieshaveshownpromisingresultsfortheuseofmolecular-targetedtherapiesinthetreatmentandpreventionofgastriccancer.

Forexample,trastuzumab,amonoclonalantibodythattargetstheHER2receptor,hasbeenshowntoimproveoverallsurvivalinpatientswithadvancedgastriccancerthatoverexpressesHER2.Similarly,ramucirumab,amonoclonalantibodythattargetstheVEGFR-2receptor,hasbeenshowntoimprovesurvivalinpatientswithadvancedgastriccancer.

Thesetargetedtherapiesmayalsohavearoleinpreventingmetachronousrecurrenceinpatientswithearly-stagegastriccancer.Forexample,arecentstudyfoundthatadjuvanttrastuzumabaftercurativeresectionforHER2-positivegastriccancerwasassociatedwithasignificantreductionintheriskofrecurrence.

Otherpotentialtargetedtherapiesforpreventingmetachronousrecurrenceingastriccancerincludeimmunecheckpointinhibitors,whichhaveshownpromisingresultsinadvancedgastriccancer,andtyrosinekinaseinhibitors,whichtargetavarietyofreceptorsandsignalingpathwaysinvolvedingastriccancer.

Whiletargetedtherapiesholdpromiseforreducingtheriskofmetachronousrecurrenceinpatientswithearly-stagegastriccancerwhoundergoER,furtherresearchisneededtoidentifytheoptimaltreatmentstrategiesandpatientpopulationsfortheseinterventions.Inthemeantime,riskstratificat