Meta analysis and systematic review of treatment for gastrointestinal stromal tumor metastasis or recurrence
章笑 1余杰达 2吴芳 3叶再元3
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作者信息
1. 浙江中医药大学研究生院,杭州 310022
2. 余姚市第四人民医院消化内科,余姚 315470
3. 浙江省人民医院(杭州医学院附属人民医院)普通外科胃肠胰外科,杭州 310014
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摘要
目的 比较手术切除联合酪氨酸激酶抑制剂(TKI)与单独TKI在复发或转移性胃肠间质瘤(GIST)患者中的治疗效果.方法 在PubMed和Web of Science等数据库中检索文献,严格按照纳入标准,选取关于手术切除联合TKI与单独TKI在复发或转移性GIST患者中应用的相关文献,就患者的生存获益情况[无进展生存期(PFS)和总生存期(OS)]进行meta分析.结果 本次meta分析共纳入8项研究的647例患者,其中6项研究在亚洲进行,2项在欧洲进行,Newcastle Ottawa质量评估量表评分均≥6分.8项研究均评估了手术切除联合TKI与单独TKI治疗患者的OS,其中有4项同时评估了 PFS.Meta分析结果显示,与单独TKI治疗相比,手术切除联合TKI治疗改善了复发或转移性GIST患者的OS(P＜0.001).结论 对于复发或转移性GIST患者而言,相较于单纯TKI治疗,在TKI(如伊马替尼)控制病情后进行残留病灶手术切除给患者带来了显著的生存益处.将手术干预与TKI治疗相结合应被视为改善复发或转移性GIST患者预后的可行治疗策略.
Abstract
Objective To compare the therapeutic effects of surgical resection combined with tyrosine kinase inhibitors(TKI)and TKI alone in patients with recurrent or metastatic gastrointestinal stromal tumors(GIST).Methods Literature was searched in databases such as PubMed and Web of Science,and relevant literature on the application of surgical resection combined with TKI and TKI alone in patients with recurrent or metastatic GIST was selected strictly according to inclusion criteria.Meta analysis was conducted on the survival benefits of patients,including progression free survival(PFS)and overall survival(OS).Results A total of 647 patients from 8 studies were included in this meta-analysis,with 6 studies conducted in Asia and 2 in Europe.The Newcastle Ottawa Quality Assessment Scale scores were all ≥6.Eight studies were conducted to evaluate the overall survival of patients treated with surgical resection combined with TKI and TKI alone,with four studies simultaneously assessing PFS.The meta-analysis results showed that compared with TKI treatment alone,surgical resection combined with TKI treatment significantly improved the overall survival(OS)of patients with recurrent or metastatic GIST(P＜0.001).Conclusions For patients with recurrent or metastatic GIST,compared to simple TKI treatment,surgical resection of residual lesions after TKI(such as imatinib)control of the condition brings significant survival benefits to patients.Combining surgical intervention with TKI treatment should be considered a feasible treatment strategy to improve the prognosis of patients with recurrent or metastatic GIST.
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