胃癌肝转移手术治疗预后的Meta分析

目的系统评价胃癌原发灶联合肝脏切除治疗胃癌肝转移（GCLM）的临床价值及其与预后的相关性。方法检索2013年3月前在PubMed、Embase、Ovid、Springer-Link、WebofScience以及中国期刊全文数据库（CNKI）和中国生物医学文献数据库（CBMdisc）等已公开发表的胃癌联合肝脏切除治疗与单纯胃癌切除治疗进行比较的临床研究，通过人选标准和排出标准筛选文献，采用NOS表对文献进行质量评价，分析软件为Statal2．0。结果共有9篇文献符合入选标准，GCLM患者431例，其中胃癌联合肝脏切除治疗组189例，单纯胃癌切除组242例。9个研究分析结果显示，胃癌原发灶联合肝转移灶切除组患者术后生存明显优于单纯胃癌切除组（合并HR=0．50，95％a：0．34～0．72。P=0．000），差异具有统计学意义。结论GCLM患者在严格手术适应证的前提下进行胃癌原发灶联合肝脏切除术可以改善预后并提高生存率。

Meta-analysis of prognosis after surgical treatment in gastric cancer patients with liver metastasis

Objective To assess the value of gastric and hepatic surgical treatment in gastric cancer patients with liver metastasis and its prognostic implication. Methods Literature search was performed in PubMed, Embase, Ovid, Springer-Link, Web of Science, CNKI, CBMdisc for clinical research published before March 2013 that compared gastrectomy alone to gastrectomy and hepatectomy. Inclusion criteria and exclusion criteria were performed. Quality assessment was based on NOS scale. Statal2.0 was used for statistical analysis. Results Nine studies including 431 patients were enrolled for analysis, among whom 189 underwent gastrectomy and hepatectomy and 242 underwent gastrectomy alone. Gastrectomy and hepatectomy group had better survival （HR=0.50, 95%CI： 0.34- 0.72, z=3.66, P=0.000）. There was a subgroup analysis. Gastreetomy with hepatectomy group had significant advantages in prognosis in four foreign studies （HR=0.28, 95%CI：0.18-0.44, z=5.77, P= 0.000）. There was no significant difference in five domestic studies （HR--0.74, 95%CI：0.55-1.00, z=1.95, P=0.051 ）. Conclusion Gastrectomy and hepatectomy in gastric cancer patients with liver metastasis improves long-term survival in select patients.