Clinicopathologic characteristics and prognosis of Borrmann type IV gastric cancer: a meta-analysis.
Clinicopathologic characteristics and prognosis of Borrmann type IV gastric cancer: a meta-analysis.
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DOI：
10.1186/s12957-016-0805-9
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发表时间：
2016-02-24
影响因子：
3.2
通讯作者：
Wang Z
中科院分区：
文献类型：
--
作者：
Luo Y;Gao P;Song Y;Sun J;Huang X;Zhao J;Ma B;Li Y;Wang Z
Borrmann IV型（B-4）胃癌的临床病理特征和外科治疗策略仍存在争议。本荟萃分析旨在评价B-4胃癌患者的临床病理特征，并评估非根治性切除是否改善预后。检索PubMed和Embase中的相关文章。使用RevMan（版本5.2）进行统计分析。计算比值比（OR）、风险比（RR）、风险比（HR）及其95%置信区间（CI）和中位生存时间的加权平均值作为效应值。纳入了15项研究。与Borrmann“其他”型（B-O）相比，B-4型低分化癌发生率高（OR = 4.92，95%CI = 3.10-7.83，P < 0.01），淋巴结转移（OR = 2.13，95%CI = 1.88-2.41，P < 0.01），腹膜转移（OR = 3.91; 95% CI = 3.37-4.54; P < 0.01）、浆膜浸润（OR = 3.66; 95% CI = 2.91-4.60; P < 0.01）、淋巴管浸润（OR = 1.39; 95% CI = 1.02-1.91; P = 0.04）。B-4例非根治性切除患者的生存率较差（HR = 2.83; 95% CI = 2.35-3.40; P < 0.01），而非根治性切除的B-4组患者生存率较好（1年：RR = 0.70，95% CI = 0.63-0.77; P < 0.01; 2年：RR = 0.90，95% CI = 0.85-0.94; P < 0.01）。我们的荟萃分析表明，B-4患者与肿瘤分化差、淋巴结转移、腹膜转移、浆膜浸润、淋巴管浸润和预后相关。根治性切除可提高B-4患者的生存率。如果不能进行根治性切除，非根治性切除可改善预后。
The clinicopathologic features and surgical treatment strategy of Borrmann type IV (B-4) gastric cancer remains controversial. This meta-analysis was conducted to evaluate the clinicopathologic features of patients with B-4 gastric cancer and to assess whether or not non-curative resection improved prognosis. PubMed and Embase were searched for relevant articles. Statistical analysis was performed using RevMan (version 5.2). The odds ratio (OR), risk ratio (RR), hazard ratio (HR) with 95 % confidence interval (CI), and weighted average of median survival times were calculated as effect values. Fifteen studies were included. Compared with Borrmann type “others” (B-O), B-4 had a higher incidence of poorly differentiated carcinoma (OR = 4.92; 95 % CI = 3.10–7.83; P < 0.01), lymph node metastases (OR = 2.13; 95 % CI = 1.88–2.41; P < 0.01), peritoneal metastases (OR = 3.91; 95 % CI = 3.37–4.54; P < 0.01), serosal invasion (OR = 3.66; 95 % CI = 2.91–4.60; P < 0.01), and lymphatic invasion (OR = 1.39; 95 % CI = 1.02–1.91; P = 0.04). B-4 patients with non-curative resection were associated with a worse survival rate (HR = 2.83; 95 % CI = 2.35–3.40; P < 0.01) than patients with curative resection; however, B-4 patients with non-curative resection had a better survival rate (1-year: RR = 0.70, 95 % CI = 0.63–0.77; P < 0.01; 2-year: RR = 0.90, 95 % CI = 0.85–0.94; P < 0.01) than patients with non-resection. Our meta-analysis indicated that B-4 patients were associated with poor tumor differentiation, lymph node metastases, peritoneal metastases, serosal invasion, lymphatic invasion, and prognosis. Curative resection may increase the survival rate for B-4 patients. If it is not possible to perform a curative resection, a non-curative resection may improve the prognosis.