A cohort study and meta-analysis of the evidence for consideration of Lauren subtype when prescribing adjuvant or palliative chemotherapy for gastric cancer
A cohort study and meta-analysis of the evidence for consideration of Lauren subtype when prescribing adjuvant or palliative chemotherapy for gastric cancer
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在为胃癌开出辅助或姑息化疗时考虑 Lauren 亚型的证据的队列研究和荟萃分析
DOI：
10.1177/1758835920930359
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发表时间：
2020-01
影响因子：
4.9
通讯作者：
Kunning Wang
中科院分区：
文献类型：
--
作者：
Kunning Wang
背景：Lauren亚型胃癌(GC)与化疗的存活率或疗效之间的关系尚不清楚。我们的目的是阐明不同Lauren亚型的患者在全身化疗后的生存情况是否不同：肠型胃癌(IGC)患者的生存率高于混合型胃癌(MGC)和弥漫型胃癌(DGC)患者的全身化疗后的生存率。患者与方法：通过检索Pubmed、Embase、Cochrane和Ovid检索到2020年3月为止的Meta分析相关研究。我们还纳入了我们自己的前瞻性收集的患者队列，这些患者被跟踪了10年。还进行了分组和敏感性分析。结果：在我们的前瞻性队列中，接受全身化疗的胃癌患者的总生存期[中位数OS5.01 年，四分位数范围2.63~6.71]显著高于接受化疗的中位数OS1.33 年，IQR0.78~3.33，p = 0.0001。在调整了年龄、性别和癌症分期后，根据Lauren GC分类进行化疗的患者的OS有显著差异[IGCOS的风险比(HR)与DGC0.33，[95%可信区间(CI)，0.17-0.65；p <； 0.001]}。在糖耐量低减患者中，与化疗相关的校正HR为0.26(95%CI，0.12~0.56；p = 0.001)，而在直肠癌患者组中，调整后的HR为0.64(95%CI，0.30~1.33；p = 0.23)。在我们的荟萃分析中，33项研究，包括10,246名接受全身化疗的患者(化学IGC n = 4888，化学DGC n = 5358)符合所有选择标准。虽然我们解释了这些研究中的大部分异质性，但我们发现，与接受类似治疗的化疗DGC患者相比，化疗IGC患者的OS显著改善[HR，0.76(95%CI，0.71-0.82)；p <； 0.00001]。结论：我们的结果支持在为GC，特别是对化疗可能无效的MGC或DGC开出全身化疗处方时考虑Lauren亚型。在未来的临床试验中，应考虑Lauren分类对GC患者的化疗方案进行分层，特别是与目前的方案更难治疗的MGC或DGC有关。
Background: The association between the survival or efficacy of chemotherapy and the Lauren subtype of gastric cancer (GC) remains unclear. We aimed to clarify whether patients with different Lauren subtypes have different survival after treatment with systemic chemotherapy: intestinal gastric cancer (IGC) patients survived better than patients with mixed type gastric cancer (MGC) or diffuse gastric cancer (DGC) after treatment with systemic chemotherapy. Patients & methods: Relevant studies for the meta-analysis were identified through searching Pubmed, Embase, Cochrane and Ovid up to March 2020. We also included our own prospectively collected cohort of patients that were followed over a 10-year period. Sub-group and sensitivity analyses were also performed. Results: In our prospective cohort, the overall survival (OS) of IGC patients receiving systemic chemotherapy (chemoIGC) [median OS 5.01 years, interquartile range (IQR) 2.63–6.71] was significantly higher than that of DGC patients receiving the same chemotherapy (chemoDGC) (median OS 1.33 years, IQR 0.78–3.33, p = 0.0001). After adjusting for age, gender and cancer stage, there was a significant difference in OS in patients treated with chemotherapy based on the Lauren classification of GC {hazard ratio (HR) for OS of the IGC versus DGC 0.33, [95% confidence interval (CI), 0.17–0.65; p < 0.001]}. In the IGC patients, the adjusted HR associated with chemotherapy was 0.26 (95% CI, 0.12–0.56; p = 0.001), whereas the association was 0.64 (95% CI, 0.30–1.33; p = 0.23) in the DGC patient group. In our meta-analysis, 33 studies comprising 10,246 patients treated with systemic chemotherapy (chemoIGC n = 4888, chemoDGC n = 5358) met all the selection criteria. While we accounted for much of the heterogeneity in these studies, we found that chemoIGC patients showed significantly improved OS [HR, 0.76 (95% CI, 0.71–0.82); p < 0.00001] when compared with similarly treated chemoDGC patients. Conclusion: Our results support the consideration of Lauren subtype when prescribing systemic chemotherapy for GC, particularly for MGC or DGC, which may not benefit from chemotherapy. Lauren classification should be considered to stratify chemotherapy regimens to GC patients in future clinical trials, with particular relevance to MGC or DGC, which is more difficult to treat with current regimens.
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影响因子：
51.1
作者：
Cats, Annemieke;Jansen, Edwin P. M.;Verheij, Marcel
通讯作者：
Verheij, Marcel
影响因子：
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作者：
M. Kucukoner;A. Işıkdoğan;E. Arpacı;M. Bilici;D. Uncu;B. Cetin;F. Dane;M. Inane;M. Kaplan;K. Çayır;T. Yetişyiğit;N. Ozdemir;A. Inal;S. Aksoy;N. Alkiş;S. B. Tekin;C. Eroglu;S. Turhal;M. Benekli;S. Buyukberber
通讯作者：
M. Kucukoner;A. Işıkdoğan;E. Arpacı;M. Bilici;D. Uncu;B. Cetin;F. Dane;M. Inane;M. Kaplan;K. Çayır;T. Yetişyiğit;N. Ozdemir;A. Inal;S. Aksoy;N. Alkiş;S. B. Tekin;C. Eroglu;S. Turhal;M. Benekli;S. Buyukberber
影响因子：
7.4
作者：
Sawaki, Akira;Ohashi, Yasuo;Omuro, Yasushi;Satoh, Taroh;Hamamoto, Yasuo;Boku, Narikazu;Miyata, Yoshinori;Takiuchi, Hiroya;Yamaguchi, Kensei;Sasaki, Yasutsuna;Nishina, Tomohiro;Satoh, Atsushi;Baba, Eishi;Tamura, Takao;Abe, Takashi;Hatake, Kiyohiko;Ohtsu, Atsushi
通讯作者：
Ohtsu, Atsushi
DOI：
10.1016/s0739-5930(08)70072-2
发表时间：
2007
期刊：
Yearbook of Gastroenterology
影响因子：
--
作者：
Edith Rodríguez Braun;Alejandro Pérez Fidalgo
通讯作者：
Edith Rodríguez Braun;Alejandro Pérez Fidalgo
影响因子：
7.4
作者：
Takashima, Atsuo;Boku, Narikazu;Ohtsu, Atsushi
通讯作者：
Ohtsu, Atsushi