目的:本研究的目的是调查接受内镜黏膜下剥离术(ESD)的早期胃癌(EGC)老年患者和接受手术治疗的早期胃癌患者的总生存期(OS)是否存在差异。
方法:四个数据库,包括PubMed、Embase,Cochrane图书馆和CKNI于2023年3月20日进行了搜索。研究的特点和患者的基线信息,包括他们的病史,术后数据,和预测,被记录下来。赔率比(OR)或平均差(MD),和95%置信区间(CIs)合并计算基线信息和术后信息.使用危险比(HR)和95%CI来计算患者的预后。采用StataV16.0软件进行数据分析。
结果:本研究共纳入8项研究,包括2334例患者。汇集数据后,我们发现ESD组的东部肿瘤协作组(ECOG)得分较低(OR=0.33,95%CI=0.17至0.65,I2=59.69%,P=0.00<0.05)比手术组。手术时间差异有统计学意义(MD=-3.38,95%CI=-5.19~-1.57,I2=98.31%,P=0.00<0.05),住院时间(MD=-3.01,95%CI=-4.81至-1.20,I2=98.83%,P=0.00<0.05)和住院费用(MD=-2.67,95%CI=-3.59至-1.75,I2=93.21%,两组间P=0.00<0.05)。ESD组OS率较低(HR=2.81,95%CI=2.20~3.58,I2=12.28%,P=0.00<0.05)。
结论:接受ESD的老年EGC患者的OS率明显低于接受手术的患者。如果病人的情况合适,仍建议对这些患者进行手术治疗.
OBJECTIVE: The aim of this study was to investigate whether there was a difference in overall survival (OS) between elderly patients with early gastric cancer (EGC) who underwent endoscopic submucosal dissection (ESD) and those who underwent surgery.
METHODS: Four databases including PubMed, Embase, the Cochrane Library and CKNI were searched on March 20, 2023. The characteristics of the studies and the baseline information of the patients, including their medical histories, postoperative data, and prognoses, were recorded. Odds ratios (ORs) or mean differences (MDs), and 95% confidence intervals (CIs) were pooled up to calculate baseline information and postoperative information. Hazard ratios (HRs) and 95% CIs were used to calculate the prognosis of the patients. Stata V16.0 software was used for the data analysis.
RESULTS: A total of eight studies involving 2334 patients were included for the data analysis in this study. After pooling up the data, we found that the ESD group had lower Eastern Cooperative Oncology Groupprevious (ECOG) scores (OR = 0.33, 95% CI = 0.17 to 0.65, I2 = 59.69%, P = 0.00 < 0.05) than the surgery group. There were significant differences in the operation time (MD = -3.38, 95% CI = -5.19 to -1.57, I2 = 98.31%, P = 0.00 < 0.05), length of hospital stay (MD = -3.01, 95% CI = -4.81 to -1.20, I2 = 98.83%, P = 0.00 < 0.05) and hospitalization expenses (MD = -2.67, 95% CI = -3.59 to -1.75, I2 = 93.21%, P = 0.00 < 0.05) between the two groups. The ESD group had a lower OS rate (HR = 2.81, 95% CI = 2.20 to 3.58, I2 = 12.28%, P = 0.00 < 0.05).
CONCLUSIONS: Elderly patients with EGC who underwent ESD had a significantly worse OS rate than those who underwent surgery. If the patient\'s condition was suitable, surgery was still recommended for these patients.