How commonly is upper gastrointestinal cancer missed at endoscopy? A meta-analysis.
How commonly is upper gastrointestinal cancer missed at endoscopy? A meta-analysis.
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DOI：
10.1055/s-0034-1365524
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发表时间：
2014-06
影响因子：
2.6
通讯作者：
Trudgill N
中科院分区：
文献类型：
--
作者：
Menon S;Trudgill N
研究背景和研究目的：西方世界的上消化道（UGI）癌症通常出现在晚期，此时治愈性治疗的机会有限。内窥镜检查未能发现细微的早期UGI癌可能导致预后不良。我们对UGI癌症的内窥镜漏诊率研究进行了荟萃分析，以量化在早期阶段诊断癌症的机会被错过的频率。 患者和方法：进行MEDLINE检索以识别相关研究，并进行荟萃分析。“漏诊”UGI癌症定义为在诊断前3年内未通过UGI内窥镜检查诊断的癌症。随机效应荟萃分析用于确定漏诊UGI癌症的事件率。 结果：确定了10项研究，包括3，787例UGI癌症患者。487例UGI癌症在诊断前3年内在内窥镜检查中被遗漏。研究间观察到显著的异质性（I2，94.4%，P <0.001）. 在随机效应荟萃分析中，诊断前1年内的合并漏诊率为6.4%（95%置信区间[CI]，4.3%-9.5%），诊断前3年内的漏诊率为11.3%（95%置信区间[CI]，7.5%-16.6%）。 食管癌（44%）和胃癌（51%）的漏诊率似乎没有差异（P = 0.42）。 结论11.3%的上消化道癌在确诊前3年内内镜检查漏诊. 为了改善西方世界UGI癌症患者预后不良的状况，应努力提高UGI内窥镜检查的质量，为早期诊断创造机会。
Background and study aims: Upper gastrointestinal (UGI) cancer in the Western world usually presents at an advanced stage, when opportunities for curative therapy are limited. The failure to detect subtle, early-stage UGI cancer at endoscopy may contribute to a poor prognosis. We undertook a meta-analysis of studies of endoscopic miss rates for UGI cancer to quantify how often opportunities to diagnose cancer at an earlier stage are missed. Patients and methods: A MEDLINE search was conducted to identify relevant studies, and a meta-analysis was conducted. “Missed” UGI cancer was defined as cancer that had not been diagnosed by UGI endoscopy performed within 3 years before the diagnosis. Random effects meta-analysis was used to determine the event rate of missed UGI cancer. Results: Ten studies were identified that included 3,787 patients with UGI cancer. Four hundred eighty-seven UGI cancers were missed at endoscopy within 3 years before diagnosis. Marked heterogeneity was observed between studies (I 2, 94.4 %; P < 0.001). On random effects meta-analysis, the pooled miss rates were 6.4 % (95 % confidence interval [CI], 4.3 % – 9.5 %) within 1 year and 11.3 % (95 % CI, 7.5 % – 16.6 %) within 3 years before diagnosis. There appeared to be no difference between the miss rates of oesophageal (44 %) and gastric (51 %) cancer (P = 0.42). Conclusion It appears that 11.3 % of UGI cancers are missed at endoscopy up to 3 years before diagnosis. To ameliorate the poor prognosis of patients with UGI cancer in the Western world, efforts should be made to improve the quality of UGI endoscopy and create opportunities for earlier diagnosis.
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影响因子：
9.3
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Hosokawa, O;Tsuda, S;Hinoshita, T
通讯作者：
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