近端胃癌的全胃切除术与近端胃切除术术后5年生存率 Meta 分析

摘要

Objective To systematically review the 5-year survival after total gastrectomy(TG) and proximal gastrectomy(PG)for proximal gastric cancer.Methods We searched PubMed,Ov-id,Cochrane Central,Karger,CNKI,Wanfang and VIP Databases from January 2005 to December 2015 to collect the literatures about TG and PG for proximal gastric cancer.Two reviewers screened literatures,evaluated the quality of included studies and extracted 5-year survival data, and then meta-analysis was performed by using RevMan 5.3 software.Results A total of 16 studies were analyzed,including 13 studies in China and 3 studies abroad(2521 patients,1289 in TG group and 1232 in PG group).There was a significant difference in 5-year survival rate be-tween TG group and PG group(OR = 1.54,95% CI = 1.26-1.90,P <0.000 1).In addition,the difference in 5-year survival rate was significant among the 13 studies in China(OR=1.72,95%CI =1.39-2.13,P <0.000 01),as well as among the 3 studies abroad(OR=0.32,95% CI =0.13-0.78,P =0.01).However,the direction of combined effect was opposite in the two subgroups. Conclusion In general,TG results in a higher 5-year survival rate than PG in patients with proxi-mal gastric cancer.However,more high-quality researches are needed to verify this conclusion due to the opposite results obtained in China and abroad.%目的：系统评价全胃切除术（total gastrectomy，TG）与近端胃切除术（proximal gastrectomy，PG）治疗近端胃癌的术后5年生存情况。方法计算机检索 PubMed、OVID 数据库、Cochrane Central 临床试验数据库、Karger医学电子期刊、中国期刊网 CNKI、万方数据知识服务平台、维普中文科技期刊数据库，收集国内外 TG 与 PG 治疗近端胃癌的文献，检索时限为2005年1月至2015年12月。由两名研究者独立进行文献筛选、资料提取和评价纳入研究的质量后，提取5年生存率资料，采用 RevMan5．3软件进行 Meta 分析。结果共纳入16个研究，其中国内研究13个，国外研究3个；总病例数2521例，其中 TG 组1289例，PG 组1232例。2组总的5年生存率的差异有统计学意义（OR＝1．54，95％CI ：1．26～1．90，P ＜0．0001）。13个国内研究5年生存率的差异有统计学意义（OR＝1．72，95％CI ：1．39～2．13，P ＜0．00001）；3个国外研究5年生存率的差异也有统计学意义（OR ＝0．32，95％CI ：0．13～0．78，P ＝0．01），但效应值的方向相反。结论总体来看，近端胃癌患者的术后5年生存率全胃切除术可能优于近端胃切除术。由于国外研究结果与国内相反，该结论尚需更多高质量研究进行验证。