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中华结直肠疾病电子杂志 ›› 2021, Vol. 10 ›› Issue (06) : 631 -637. doi: 10.3877/cma.j.issn.2095-3224.2021.06.010

论著

肿瘤间质成熟度与结直肠癌预后关系的Meta分析
杨伟1, 陈洁静1, 吴巍1, 刘茂安1, 戴勇1, 倪庆1,()   
  1. 1. 225100 扬州大学附属医院普外科
  • 收稿日期:2021-03-26 出版日期:2021-12-25
  • 通信作者: 倪庆

The relationship between tumor stromal maturity and prognosis of colorectal cancer: a Meta analysis

Wei Yang1, Jiejing Chen1, Wei Wu1, Maoan Liu1, Yong Dai1, Qing Ni1,()   

  1. 1. Department of General Surgery, the Affiliated Hospital of Yangzhou University, Yangzhou 225100, China
  • Received:2021-03-26 Published:2021-12-25
  • Corresponding author: Qing Ni
引用本文:

杨伟, 陈洁静, 吴巍, 刘茂安, 戴勇, 倪庆. 肿瘤间质成熟度与结直肠癌预后关系的Meta分析[J/OL]. 中华结直肠疾病电子杂志, 2021, 10(06): 631-637.

Wei Yang, Jiejing Chen, Wei Wu, Maoan Liu, Yong Dai, Qing Ni. The relationship between tumor stromal maturity and prognosis of colorectal cancer: a Meta analysis[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2021, 10(06): 631-637.

目的

探讨肿瘤间质成熟度与结直肠癌预后的关系。

方法

检索万方、中国知网、Cochrane Library、PubMed、SpringerLink、EBSCO、MEDLINE等数据库,以“肿瘤间质成熟度”“促纤维间质反应”“促纤维反应”“间质反应”“间质反应程度“间质分级”“间质密度”“结直肠癌”“预后”“tumor stroma maturity”“desmoplastic stroma reaction”“desmoplastic reaction”“stroma reaction”“degree of stroma reaction”“stroma classification”“stroma density”“colorectal cancer”“colon cancer”“rectal cancer”“prognosis”为检索词检索从建库至2021年1月所有研究肿瘤间质成熟度与结直肠癌预后关系的文献,提取相关临床资料和数据,根据纳入和排除标准,并根据NOS量表评估文献质量,最后采用RevMan5.4及R语言“metafor”包进行Meta分析。

结果

最终纳入15篇文献共19个队列9 849例结直肠癌患者的资料,其中成熟型4 339例(对照组),中间型3 048例(中间型组),不成熟型2 456例(不成熟型组),Meta分析结果显示:不成熟型组患者无复发生存率(HR=2.66,95%CI:2.30~3.08;P<0.00001)、无病生存率(HR=3.68,95%CI:2.33~5.81;P<0.00001)和总生存率(HR=1.70,95%CI:1.53~1.87;P<0.00001)均明显低于成熟型组(对照组);中间型组患者无复发生存率(HR=1.36,95%CI:1.17~1.59;P<0.0001)和无病生存率(HR=1.85,95%CI:1.53~2.24;P<0.0001)亦明显低于成熟型组(对照组)。

结论

肿瘤间质成熟度与结直肠癌预后密切相关。

Objective

To investigate the relationship between tumor stromal maturity and prognosis of colorectal cancer.

Methods

The literatures researching the relationship between tumor stromal maturity and prognosis of colorectal cancer were searched in the Wangfang, CNKI, CochraneLibrary, PubMed, SpringerLink, EBSCO, MEDLINE and other databases from database construction to January 2021, "tumor stroma maturity" "desmoplastic stroma reaction" "desmoplastic reaction" "stroma reaction" "degree of stroma reaction" "stroma classification" "stroma density" "colorectal cancer" "colon cancer" "rectal cancer" "prognosis" were selected as keywords, relevant clinical data were extracted according to the inclusion and exclusion criteria, and the quality of literatures were evaluated according to NOS form, the Meta-analysis was performed by RevMan5.4 and "metafor" R package.

Results

A total of 15 articles including 9 849 colorectal cancer patients in 19 cohorts were analysed in this Meta-analysis. These cohorts were composed by 4 339 patients with mature stroma (control group), 3 048 patients with intermediate stroma (intermediate group) and 2 456 patients with immature troma (immature group). The Meta-analysis results showed that there was significant difference between the immature group and control group in recurrence-free survival (HR=2.66, 95%CI: 2.30~3.08; P<0.00001), disease-free survival (HR=3.68, 95%CI: 2.33~5.81, P<0.00001) and overall survival (HR=1.70, 95%CI: 1.53~1.87; P<0.00001); there was also significant difference between the intermediate group and control group in RFS (HR=1.36, 95%CI: 1.17~1.59, P<0.0001) and DFS (HR=1.85, 95%CI: 1.53~2.24, P<0.0001).

Conclusion

The prognosis of colorectal cancer was closely related to the tumor stromal maturity.

图1 文献检索流程图
表1 纳入研究的基本特征及NOS量表评分(
xˉ
±s,例)
研究 时间 国家 研究类型 样本量 性别(男/女)

年龄

(岁)

分期 肿瘤部位(结肠/直肠) 分化程度(高/中/低) DR(不成熟/中间型/成熟) 随访时间(月) 结局 NOS评分
Ueno5 2002 英国 队列 627 393/234 60.3±12 Ⅰ~Ⅲ NA 140/402/85 72/159/396 153(80~267) OS 6
Ueno6 2004 日本 队列 862 NA NA Ⅰ~Ⅲ 直肠 NA 125/284/453 140 OS 6
Ueno7 2014 日本 队列 412 NA 61.4±12 NA 205/190/11 153/122/137 61(11~188) OS、DFS 6
Ueno(1)8 2015 日本 队列 880 512/368 62.9±13 Ⅱ~Ⅲ 609/271 256/574/50 192/275/413 68 DFS、OS 7
Ueno(2)8 2015 日本 队列 474 268/206 66.3±13 Ⅱ~Ⅲ 382/92 201/232/41 82/170/222 68 DFS、OS 8
Ueno9 2017 日本 队列 821 484/337 66.2±12 Ⅱ~Ⅲ 510/311 401/365/55 214/282/325 59(1~86) RFS、DSS 7
Ueno(1)10 2018 日本 队列 466 264/202 59.9±13 276/190 202/231/33 169/133/164 59(45~144) RFS 7
Ueno(2)10 2018 日本 队列 432 247/185 65.1±12 251/181 181/216/35 145/140/147 58(1~87) RFS 8
Shin11 2019 韩国 队列 151 88/63 63.2±11 Ⅰ~Ⅳ 47/104 11/130/5 30/91/60 56 OS 7
Konishi12 2018 美国 队列 851 407/444 66±14 Ⅰ~Ⅲ 454/397 NA 95/256/500 58 RFS 8
Nearchou(1)13 2019 日本 队列 283 184/99 62.3±11 92/76/115 145/25/113 88/105/90 NA OS 7
Nearchou(2)13 2019 英国 队列 163 87/76 63±12 65/57/41 2/93/25 28/79/56 NA OS 8
Ueno(1)14 2019 日本 队列 679 400/279 64.0±12 458/221 276/368/35 430/180/69 91 RFS、OS 8
Ueno(2)14 2019 日本 队列 446 267/179 67.0±12 287/159 253/171/22 235/142/69 58 RFS、OS 9
Gonzalez15 2020 美国 队列 342 179/163 65.2±12.6 Ⅰ~Ⅲ 204/138 148/104/90 66/133/143 NA RFS 6
Hacking16 2020 美国 队列 234 111/118 64±13 Ⅰ~Ⅲ 105/33/42 106/68/60 28/48/152 NA DFS 6
Ao17 2020 日本 队列 363 209/154 66.6±12 203/160 121/212/30 148/106/109 61(1~136) RFS 6
Gonzalez18 2021 美国 队列 372 189/183 65.7±12.9 Ⅰ~Ⅲ 227/145 294/56/22 67/140/165 62(1~170) RFS 6
Ueno19 2021 日本 队列 991 601/390 65.5 807/184 420/526/45 59/294/638 69.7(2.1~105.6) RFS 8
图2 肿瘤间质不成熟组与成熟组患者无复发生存率比较的Meta分析结果
图3 肿瘤间质中间型组与成熟组患者无复发生存率比较的Meta分析结果
图4 肿瘤间质不成熟组与成熟组患者无病生存率比较的Meta分析结果
图5 肿瘤间质中间型组与成熟组患者无病生存率比较的Meta分析结果
图6 肿瘤间质不成熟组与成熟组患者总生存率比较的Meta分析结果
图7 肿瘤间质不成熟组与成熟组患者无复发生存率比较的Meta分析漏斗图
表2 复发生存率和总生存率的Meta回归分析
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