教科书结果（TO）与教科书肿瘤学结果（TOO）对食管胃癌手术生存期的影响：系统综述与Meta分析
Impact of Textbook Outcome (TO) and Textbook Oncological Outcome (TOO) on Survival Following Surgery for Esophagogastric Cancer: A Systematic Review and Meta-analysis.
作者
作者单位
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom. Shahd.mobarak@postgrad.manchester.ac.uk.
- Department of Upper Gastrointestinal Surgery, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom.
- Centre for Biostatistics, School of Health Science, Faculty of Biology, Medicine and Healths, University of Manchester, Manchester, United Kingdom.
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
摘要
中文
教科书结果（Textbook Outcome, TO）和教科书肿瘤学结果（Textbook Oncological Outcome, TOO）越来越多地作为手术成功的复合指标，但其定义存在异质性。本系统综述和Meta分析旨在综合探讨复合结局指标（TO/TOO）与胃癌和食管癌生存期之间的关系。根据系统综述和Meta分析首选报告项目（PRISMA）指南进行了系统检索。检索了六个数据库，纳入符合标准的比较研究。主要结局包括总生存期（OS）和无病生存期（DFS）。采用随机效应模型对胃切除术和食管切除术进行汇总，计算合并风险比（HR）及95%置信区间（CI）。共分析了46项回顾性队列研究，包括159,320例患者（28项胃切除术，14项食管切除术，4项两者均包括）。TO/TOO的定义差异较大。胃切除术的TO/TOO中位实现率为51.5%（IQR 34.3-60.5%），食管切除术为35.1%（IQR 30.7-50.8%）。实现TO/TOO与胃切除术后OS改善相关（HR 0.60；95% CI 0.54-0.67），也与食管切除术后OS改善相关（HR 0.69；95% CI 0.63-0.76）。在胃切除术后（HR 0.54；95% CI 0.42-0.70）和食管切除术后（HR 0.69；95% CI 0.61-0.79）实现TO/TOO的患者DFS均有所改善。当使用标准化TO定义汇总研究时，异质性几乎消失（胃切除术OS：I²：1%，P=0.41；食管切除术OS：I²：0%，P=0.28）。实现TO/TOO的患者中位1年、3年和5年OS及DFS率持续更高。实现TO/TOO与食管胃癌手术中OS和DFS的显著改善相关。这些发现支持复合结局指标作为长期肿瘤学结局指标的作用，并强调标准化的必要性。
English
Textbook outcome (TO) and textbook oncological outcome (TOO) are increasingly used as composite measures of surgical success but are limited by heterogeneity in their definitions. This systematic review and meta-analysis aims to synthesize the association between composite outcome measures (TO/TOO) and survival in both gastric and esophageal cancer. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases were searched for comparative studies meeting the inclusion criteria. Primary outcomes included overall survival (OS) and disease-free survival (DFS). Random-effects meta-analyses were performed for gastrectomy and esophagectomy using pooled hazard ratios (HRs) with 95% confidence intervals (CIs). A total of 46 retrospective cohort studies including 159,320 patients were analyzed (28 gastrectomy, 14 esophagectomy, 4 both). Definitions of TO/TOO varied substantially. Median achievement rates were 51.5% (IQR 34.3-60.5%) for gastrectomy and 35.1% (IQR 30.7-50.8%) for esophagectomy. Achievement of TO/TOO was associated with improved OS following gastrectomy (HR 0.60; 95% CI 0.54-0.67) and esophagectomy (HR 0.69; 95% CI 0.63-0.76). DFS was improved in patients achieving TO/TOO following gastrectomy (HR 0.54; 95% CI 0.42-0.70) and esophagectomy (HR 0.69; 95% CI 0.61 to 0.79). Heterogeneity was almost eliminated when pooling studies using a standardized TO definition (OS in gastrectomy: I2: 1%, P = 0.41; OS in esophagectomy: I2: 0%, P = 0.28). Median 1-, 3-, and 5-year OS and DFS rates were consistently higher in patients achieving TO/TOO. Achievement of TO/TOO is associated with significantly improved OS and DFS in esophagogastric cancer surgery. These findings support the role of composite outcome measures as indicators of long-term oncological outcomes and highlight the need for standardization.
分类与指标
- 研究类型
- 综述Meta
- 病种
- 食管癌
- JCR 分区
- Q1
- 影响因子
- 3.8
- 新锐分区
- 2区