缓解性干预是否值得在晚期胃癌中冒风险? 一个系统的审查
Alicia A Gingrich1, Renceh B Flojo2, Allyson Walsh3
1Department of Surgery, MD Anderson Cancer Center, Houston, TX 77030, USA.
Journal of clinical medicine
|October 16, 2024
概括
晚期胃癌 (GC) 的息手术提供了有限的生存益处. 系统化疗对于改善结果至关重要,特别是当与息性胃切除术或外科绕道术相结合时.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 胃癌 (GC) 往往是晚诊断的,导致预后不佳和治疗选择有限.
- 目前对晚期GC的治疗指南尚不清楚,特别是关于息性手术的作用和类型.
- 为了最大限度地提高长期结果,最优的息性手术方法 (息性胃切除术,外科绕道,内镜支架) 仍在争论中.
研究的目的:
- 审查目前关于转移性第四期胃癌息手术的文献.
- 评估不同息性手术干预对生存和长期结果的影响.
- 确定系统化疗与高级GC的息性手术结合的作用.
主要方法:
- 使用PubMed,MEDLINE,EMBASE和谷歌学者进行了全面的文献审查.
- 在1985年以后发表的研究中,搜索术语包括"胃癌"和"缓性手术".
- 92篇符合转移性,IV期GC和干预 (手术或化疗) 标准的文章被选择用于存活结果的数据提取.
主要成果:
- 内镜支架 (ES) 提供了快速的症状缓解,死亡率为0%.
- 息性胃切除术 (PG) 仅在接受辅助化疗的精选患者中改善了整体存活率 (OS).
- 整体存活率在外科绕道 (SB) 和PG两种化疗中都得到改善,尽管PG的死亡率高于SB.
结论:
- 在特定情况下,息切除可能会改善精心挑选的,不那么脆弱的晚期GC患者的生存系统.
- 只有缓解性手术干预,没有并发的全身化疗,不太可能产生显著的生存益处.
- 需要进一步的研究来阐明息干预,化疗和晚期胃癌的长期存活之间的相关性.
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