Prognostic Survival Associated With Left-Sided vs Right-Sided Colon Cancer A Systematic Review and Meta-analysis
Prognostic Survival Associated With Left-Sided vs Right-Sided Colon Cancer A Systematic Review and Meta-analysis
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DOI：
10.1001/jamaoncol.2016.4227
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发表时间：
2017-02-01
期刊：
影响因子：
28.4
通讯作者：
Barni, Sandro
中科院分区：
文献类型：
--
作者：
Petrelli, Fausto;Tomasello, Gianluca;Barni, Sandro
重要性原发肿瘤的位置是一个重要的预后因素，由于不同的生物学特征。然而，当决定辅助或姑息化疗时，结肠癌（CC）的起源侧仍然不代表预后参数。目的确定原发肿瘤位置的左侧与右侧在CC患者中的预后作用。数据来源我们检索了PubMed，EMBASE，科克伦图书馆，Web of Science，LILACS，CINAHL，和SCOPUS用于前瞻性或回顾性研究，报告左半结肠癌（LCC）与右半结肠癌（RCC）相比的总生存率数据。（1）进入生存分析的变量中报告了CC侧，（2）生存信息可用（根据多变量分析，总生存期[OS]在文章中报告为风险比（HR），（3）文献以英文发表。资料提取与综合根据固定效应或随机效应模型，使用LCC与RCC的OS HR合并数据。亚组分析和多变量随机效应模型荟萃回归也进行了调整的阶段分布，样本量，种族，出版年份，类型和研究质量，辅助chemotherapy.Main结局和测量HR OS（主要结局指标）被合并，以提供一个总价值。在这项分析中，所有的HR与95%CI被合并，以获得独立于其他常见的临床病理学协变量的原发肿瘤的位置（左与右位置的CC网站）的预后信息。共纳入1437846例患者，中位随访时间为65个月。左侧原发肿瘤位置与死亡风险显著降低相关（HR，0.82; 95%CI，0.79-0.84; P
IMPORTANCE Primary tumor location is emerging as an important prognostic factor owing to distinct biological features. However, the side of origin of colon cancer (CC) still does not represent a prognostic parameter when deciding for adjuvant or palliative chemotherapy.OBJECTIVE To determine the prognostic role of left vs right-sidedness of primary tumor location in patients with CC.DATA SOURCES We searched PubMed, EMBASE, The Cochrane Library, Web of Science, LILACS, CINAHL, and SCOPUS for prospective or retrospective studies reporting data on overall survival for left-sided colon cancer (LCC) compared with right-sided colon cancer (RCC).STUDY SELECTION Studies were selected if: (1) side of CC was reported among variables entered into survival analysis, (2) survival information was available (overall survival [OS] was reported in the article as hazard ratio (HR) according to multivariate analysis, (3) articles were published in the English language.DATA EXTRACTION AND SYNTHESIS Data were pooled using HRs for OS of LCC vs RCC according to fixed or random-effects models. Subgroup analysis and multivariate random-effects model meta-regression was also implemented adjusting for stage distribution, sample size, race, year of publication, type and quality of studies, and adjuvant chemotherapy.MAIN OUTCOMES AND MEASURES HRs for OS (the primary outcome measure) were pooled to provide an aggregate value. In this analysis, all HRs with 95% CIs were pooled to obtain prognostic information on the location of the primary tumor (left vs right location site of CC) independent of other common clinicopathological covariates.RESULTS An analysis was made from the 66 studies conducted. It included 1 437 846 patients with a median follow-up of 65 months. Left sided primary tumor location was associated with a significantly reduced risk of death (HR, 0.82; 95% CI, 0.79-0.84; P