术前红细胞分布宽度与胃癌患者预后关系的Meta分析

Meta-Analysis of the Relationship between Preoperative Erythrocyte Distribution Width and Prognosis in Patients with Gastric Cancer

摘要: 目的：探讨胃癌患者术前红细胞分布宽度(Red Blood Cell Distribution Width, RDW)与其预后的关系。方法：计算机检索中国知网、万方、维普、中国生物医学、PubMed、EMbase、Cochrane Library、Web of Science等数据库，收集自建库至2023年2月19日公开发表的有关胃癌患者术前RDW水平与其预后关系的文献。根据纳排标准筛选文献，对纳入的文献进行质量评价。主要研究指标包括总生存期(Overall Survival, OS)、无病生存期(Disease-Free Survival, DFS)和癌症特异生存时间(Cancer-Specific Survival, CSS)。采用Rev Man 5.4软件进行Meta分析，合并值为风险比(Hazard Ratio, HR)及95%置信区间(Confidence, CI)。结果：本次共纳入10项回顾性研究，总计1786例胃癌患者，来自中国及日本。纳入研究的纽卡斯尔–渥太华量表(Newcastle-Ottawa Scale, NOS)评分均为6分及以上。Meta分析结果显示，术前高RDW与胃癌患者OS较低显著相关(HR = 2.14, 95% CI 1.71~2.68, P < 0.00001)，与胃癌患者DFS较差显著相关(HR = 1.76, 95% CI 1.35~2.31, P < 0.0001)，与胃癌患者CSS (HR = 2.81, 95% CI 2.21~3.57, P < 0.00001)较差显著相关。结论：胃癌患者术前高RDW水平可能是中国或日本胃癌患者预后的独立危险因素；但仍然需要更大样本量、前瞻性研究进一步验证。

Abstract: Objective: To explore the relationship between preoperative red blood cell distribution width (RDW) and prognosis in patients with gastric cancer. Methods: The databases of CNKI, VIP, Wanfang, China Biomedicine, Pub Med, Cochrane Library, EMbase and Web of Science were searched by com-puter. Literatures on the relationship between preoperative RDW level and prognosis of patients with gastric cancer were collected from the establishment of the database to the publication on February 19, 2023. The literature was screened according to the exclusion criteria, and the quality of the included literature was evaluated. The main study indexes were overall survival (OS), dis-ease-free survival (DFS) and cancer-specific survival (CSS). Meta-analysis was performed using Rev Man 5.4 software and the combined values were hazard ratio (HR) and 95% confidence interval (CI). Results: A total of 1786 patients with gastric cancer were included in 10 retrospective studies, all from China or Japan. The Newcastle-Ottawa scale (NOS) scores included in the study were all 6 points or above. Meta-analysis showed that high preoperative RDW was significantly correlated with lower OS in gastric cancer patients (HR = 2.14, 95% CI 1.71~2.68, P < 0.00001), and poor DFS in gastric cancer patients (HR = 1.76, 95% CI 1.35~2.31, P < 0.0001). It was significantly associated with poor CSS (HR = 2.81, 95% CI 2.21~3.57, P < 0.00001) in gastric cancer patients. Conclusion: High preoperative RDW level may be an independent prognostic risk factor for gastric cancer pa-tients in China and Japan. However, a larger sample size and prospective studies are still needed for further verification.