近端胃癌新辅助治疗后行近端胃切除与全胃切除疗效比较的系统综述与Meta分析

doi:10.3969/j.issn.1009-976X.2026.04.004

摘要/Abstract

摘要： 目的比较新辅助治疗后近端胃癌患者行根治性近端胃切除（PG）与全胃切除（TG）的安全性和有效性。方法系统检索PubMed、Ovid、Web of Science、Cochrane Library、CNKI和万方数据库。定量合并限于提供倾向评分匹配（PSM）后可提取数据的观察性队列;随机试验的会议摘要、数据库研究、预印本及存在潜在队列重叠的研究作描述性综合。采用R软件及metafor程序包对总生存期、R0切除率、吻合口漏发生率和围手术期各结局进行Meta分析,可合并研究数不超过3项,主要报告共同效应模型结果,随机效应模型及修正Hartung-Knapp法作为敏感性分析。结果共纳入7项报告,其中3项PSM队列纳入定量合并（最多514例,PG组241例、TG组273例）;其余4项仅进行描述性合成,各报告的样本可能存在重叠,不作总例数相加。共同效应模型显示,PG与TG的总生存期（HR=0.91,95%CI：0.70~1.17）、R0切除率（RR=1.00,95%CI：0.97~1.02）、吻合口漏（RR=1.46,95%CI：0.54~3.97）和总体并发症（RR=0.97,95%CI：0.50~1.90）,差异均无统计学意义。共同效应模型下PG组手术时间的合并点估计值较低（MD=-13.79 min,95%CI：-28.1~0.70）,但研究间异质性较高。结论现有证据不足以判断新辅助治疗后PG与TG在生存、R0切除及围术期安全性方面是否存在差异。相关结论仍需前瞻性随机试验验证。

关键词: 新辅助治疗, 近端胃癌, 近端胃切除术, 全胃切除术, 系统综述, Meta分析

Abstract: Objective To compare the safety and efficacy of radical proximal gastrectomy （PG） versus total gastrectomy （TG） in patients with proximal gastric cancer after neoadjuvant therapy. Methods A systematic search was conducted in PubMed, Ovid, Web of Science, the Cochrane Library, CNKI, and Wanfang Data. Quantitative pooling was restricted to observational cohorts from which data could be extracted after propensity score matching （PSM）. Conference abstracts of randomized trials, database studies, preprints, and studies with potential cohort overlap were descriptively synthesized. Meta-analysis was performed using R software and the metafor package for overall survival, R0 resection rate, anastomotic leakage rate, and perioperative outcomes. The number of studies eligible for pooling did not exceed three. Results from the common-effect model were primarily reported, with the random-effects model and the modified Hartung-Knapp method used as sensitivity analyses. Results Seven reports were included, of which three PSM cohorts were included in the quantitative pooling （a maximum of 514 patients, 241 in the PG group and 273 in the TG group）. The remaining four reports were descriptively synthesized only; their reported sample sizes contained potential overlaps and were not summed to derive a total number of cases. The common-effect model showed no statistically significant differences between PG and TG in overall survival （HR=0.91, 95%CI： 0.70~1.17）, R0 resection rate （RR=1.00, 95%CI： 0.97~1.02）, anastomotic leakage （RR=1.46, 95%CI： 0.54~3.97）, or overall complications （RR=0.97, 95%CI： 0.50~1.90）. Operative time was shorter in the PG group under the common-effect model （MD=-13.79 min, 95% CI： -28.1 to 0.70）, but with high inter-study heterogeneity. Conclusion Current evidence is insufficient to determine whether there are differences in survival, R0 resection rates, and perioperative safety between PG and TG after neoadjuvant therapy. These findings still require validation by prospective randomized trials.

Key words: neoadjuvant therapy, proximal gastric cancer, proximal gastrectomy, total gastrectomy, systematic review, meta-analysis

中图分类号:

何俊飞, 开乌塞·吐尔洪江, 蔡秀琴, 戴伟钢, 赵日升. 近端胃癌新辅助治疗后行近端胃切除与全胃切除疗效比较的系统综述与Meta分析[J]. 岭南现代临床外科, 2026, 25(04): 230-238.

HE Junfei, KAIWUSAI·Tuerhongjiang, CAI Xiuqin, DAI Weigang, ZHAO Risheng. Proximal versus total gastrectomy for proximal gastric cancer after neoadjuvant therapy： a systematic review and meta-analysis[J]. Lingnan Modern Clinics In Surgery, 2026, 25(04): 230-238.

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