Impact of Surgical Margin Status on Survival in Gastric Cancer: A Systematic Review and Meta-Analysis

医学 荟萃分析 置信区间 分级(工程) 科克伦图书馆 危险系数 优势比 子群分析 内科学 病态的 梅德林 系统回顾 研究异质性 手术切缘 队列研究 癌症 肿瘤科 工程类 土木工程 政治学 法学
作者
Zhiyuan Jiang,Chunyu Liu,Zhaolun Cai,Chaoyong Shen,Yuan Yin,Xiaonan Yin,Zhou Zhao,Min Mu,Yu Yin,Bo Zhang
出处
期刊:Cancer Control [SAGE Publishing]
卷期号:28: 107327482110436-107327482110436 被引量:5
标识
DOI:10.1177/10732748211043665
摘要

It is inconclusive whether R1 margin determined by postoperative pathological examination indicates worse long-term survival in gastric cancer (GC) patients after curative intent resection (CIR). Hence, we aimed to systematically pool the conflicting evidence to fill this gap.The present study was performed according to the published protocol and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Published studies examining the impact of microscopic margin status on overall survival (OS) and 5-year OS rate in GC were systematically searched in PubMed, Embase, and Cochrane Library databases. RevMan 5.3 was used to conduct statistical analysis, and the Grading of Recommendations, Assessment, Development, and Evaluations approach was used to assess the certainty of evidence for each outcome.Twenty-three retrospective cohort studies including 19 992 patients were analyzed. The pooled hazard ratio for OS of 14 studies was 2.06 (95% confidence interval [CI]: 1.61-2.65, low certainty), indicating that R1 margin predicted inferior OS. Subgroup and sensitivity analyses upheld the statistical stability of this finding. The pooled odds ratio (OR) of 14 studies was .21 (95% CI: .17-.26, moderate certainty), demonstrating that the presence of R1 margins was associated with a poorer 5-year OS rate. Sensitivity analyses and most of the subgroup analyses confirmed this finding, except the "esophagogastric junction (EGJ) cancers" subgroup, which included two studies with a pooled OR of .41 (95% CI: .10-1.61).R1 margin detected by pathological examination might exhibit a high correlation with poorer OS and 5-year OS rate in GC (except EGJ cancers) patients who underwent CIR. To figure out the effect of R1 margin on survival of different stages and histological types need prospective studies with large sample sizes and standardized methods. What is the best treatment for R1 margin patients also need more in-depth and special research.
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