早期胃癌内镜切除术后异时性复发危险因素的Meta分析

早期胃癌内镜切除术后异时性复发危险因素的Meta分析早期胃癌内镜切除术后异时性复发危险因素的Meta分析

摘要：为了探讨早期胃癌内镜切除术后异时性复发的危险因素及其影响程度，进行了一次meta分析。数据来源为PubMed、Embase、CochraneLibrary和WebofScience数据库，共计检索了311篇与“早期胃癌”、“内镜切除术”、“异时性复发”有关的文献，最终纳入19篇文献进行meta分析。对19篇文献中的数据进行汇总分析后，结果显示：年龄、性别、分化程度、浸润深度、病理类型、肿瘤大小及淋巴结转移是早期胃癌内镜切除术后异时性复发的显著危险因素，其中浸润深度、病理类型及淋巴结转移显示的危险度为最高。本研究的结果可为早期胃癌内镜切除术后的患者提供有益的临床参考和指导。

关键词：早期胃癌；内镜切除术；异时性复发；危险因素；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