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

摘要：為了探討早期胃癌內(nèi)鏡切除術(shù)后異時性復(fù)發(fā)的危險因素及其影響程度，進行了一次meta分析。數(shù)據(jù)來源為PubMed、Embase、CochraneLibrary和WebofScience數(shù)據(jù)庫，共計檢索了311篇與“早期胃癌”、“內(nèi)鏡切除術(shù)”、“異時性復(fù)發(fā)”有關(guān)的文獻，最終納入19篇文獻進行meta分析。對19篇文獻中的數(shù)據(jù)進行匯總分析后，結(jié)果顯示：年齡、性別、分化程度、浸潤深度、病理類型、腫瘤大小及淋巴結(jié)轉(zhuǎn)移是早期胃癌內(nèi)鏡切除術(shù)后異時性復(fù)發(fā)的顯著危險因素，其中浸潤深度、病理類型及淋巴結(jié)轉(zhuǎn)移顯示的危險度為最高。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)；異時性復(fù)發(fā)；危險因素；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