我国不同手术方式治疗早期胃癌的经济学指标评价
|
摘要
[目的]对内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)与外科手术两种不同手术方式治疗早期胃癌的卫生经济学指标进行系统评价。[方法]计算机检索Pubmed、Embase、the Cochrane Library(2018年4期)、中国生物医学文献数据库、中国知网学术总库、万方数据库和维普中文科技期刊数据库,获得关于ESD与外科手术治疗早期胃癌的队列研究、随机对照研究,检索时限均为建库至2018年4月。由2位评价员根据纳入及排除标准独立筛选文献、提取资料并评价纳入研究的偏倚风险,应用Stata 12.0软件进行Meta分析。[结果]共纳入14项研究,其中回顾性队列研究12项,随机对照研究2项,共涉及2087个研究对象,其中ESD组919例,外科手术组1168例。Meta分析结果显示:与外科手术组相比,ESD组的手术时间[标准化均数差(SMD)=-2.26,95%可信区间(95%CI):-2.94～-1.58,P<0.05]和住院时间(SMD=-1.97,95%CI:-2.32～-1.61,P<0.05]缩短,且住院费用低(SMD=-3.01,95%CI:-3.78～-2.24,P<0.05]。[结论] ESD与外科手术相比,具有手术时间短、住院天数少、住院费用低等优势。若临床能够在严格把握适应证的前提下推广应用ESD治疗早期胃癌,或可节约部分医疗资源。
[Purpose] To perform a health economic analysis of endoscopic submucosal dissection(ESD) versus open surgery for early gastric cancer(EGC) in China. [Methods] Pubmed,Embase,the Cochrane Library(4th issue of 2018),Chinese Biomedical Literature Database,CNKI,Wanfang Database and VIP were searched for randomized controlled clinical trials and cohort studies that assessed the health economics of ESD and open surgery for treatment of early gastric cancer in China. All studies published prior to April 2018,and were assessed the risk of bias by two reviewers independently. Meta-analysis was performed with Stata 12.0 software. [Results] Fourteen studies were included in the analysis,including 12 retrospective cohort studies and 2 randomized controlled trials involving 2087 study subjects,of whom 919 received ESD and 1168 received open surgery. The operation time and the length of hospital stay in the ESD group were shorter than those in the surgery group [standard mean difference(SMD)=-2.26,95%CI:-2.94～-1.58,P<0.05 and SMD =-1.97,95% CI:-2.32 ～-1.61,P <0.05,respectively]. Compared with the surgery group,the hospitalization costs were lower(SMD =-3.01,95% CI:-3.78 ～-2.24,P <0.05) in ESD group.[Conclusion] Compared with open surgery,ESD has the advantages in shorter operation time and length of hospital stay,and lower hospitalization cost for treatment of early gastric cancer.
[Purpose] To perform a health economic analysis of endoscopic submucosal dissection(ESD) versus open surgery for early gastric cancer(EGC) in China. [Methods] Pubmed,Embase,the Cochrane Library(4th issue of 2018),Chinese Biomedical Literature Database,CNKI,Wanfang Database and VIP were searched for randomized controlled clinical trials and cohort studies that assessed the health economics of ESD and open surgery for treatment of early gastric cancer in China. All studies published prior to April 2018,and were assessed the risk of bias by two reviewers independently. Meta-analysis was performed with Stata 12.0 software. [Results] Fourteen studies were included in the analysis,including 12 retrospective cohort studies and 2 randomized controlled trials involving 2087 study subjects,of whom 919 received ESD and 1168 received open surgery. The operation time and the length of hospital stay in the ESD group were shorter than those in the surgery group [standard mean difference(SMD)=-2.26,95%CI:-2.94～-1.58,P<0.05 and SMD =-1.97,95% CI:-2.32 ～-1.61,P <0.05,respectively]. Compared with the surgery group,the hospitalization costs were lower(SMD =-3.01,95% CI:-3.78 ～-2.24,P <0.05) in ESD group.[Conclusion] Compared with open surgery,ESD has the advantages in shorter operation time and length of hospital stay,and lower hospitalization cost for treatment of early gastric cancer.
引文
[1] Torre LA,Bray F,Siegel RL,et al. Global cancer statistics,2012[J]. CA Cancer J Clin,2015,2(65):87-108.
[2] Ferlay J,Shin HR,Bray F,et al. Estimates of worldwide burden of cancer in 2008:GLOBOCAN 2008[J]. Int J Cancer,2010,12(127):2893-2917.
[3] Ferlay J,Soerjomataram I,Dikshit R,et al. Cancer incidence and mortality worldwide:sources,methods and major patterns in GLOBOCAN 2012[J]. Int J Cancer,2015,5(136):E359-E386.
[4] Barbour AP,Rizk NP,Gerdes H,et al. Endoscopic ultrasound predicts outcomes for patients with adenocarcinoma of the gastroesophageal junction[J]. J Am Coll Surg,2007,4(205):593-601.
[5] Liu GD,Li XB,Li ChR,et al. Updates on lymph node metastasis in early gastric cancer[J]. Chinese Journal of Digestive Surgery,2016,15(1):93-96.[刘国栋,李晓波,李昌荣,等.早期胃癌淋巴结转移的研究进展[J].中华消化外科杂志,2016,15(1):93-96.]
[6] Li YL. Pathology[M]. 8th ed.Beijing:People’s Health Publishing House,2013.[李玉林.病理学[M].第8版.北京:人民卫生出版社,2013.]
[7] Mantel N,Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease[J]. J Natl Cancer Inst,1959,4(22):719-748.
[8] Higgins JP,Thompson SG. Quantifying heterogeneity in a meta-analysis[J]. Stat Med,2002,11(21):1539-1558.
[9] Song F,Gilbody S. Bias in meta-analysis detected by a simple,graphical test. Increase in studies of publication bias coincided with increasing use of meta-analysis[J].BMJ,1998,7129(316):471.
[10] Shi DM,Shao HG. Comparative analysis of the clinical effects of ESD and conventional surgical treatment for EGC patients[J]. Oncology Progress,2017,15(7):777-779.[时冬梅,邵红刚. ESD与传统手术治疗早期胃癌患者的临床效果对比分析[J].癌症进展,2017,15(7):777-779.]
[11] Xu G,Su J,Hua TY,et al. Evaluation of efficacy and prognosis of endoscopic submucosal dissection and traditional surgery for early gastric cancer[J]. Chinese Journal of Clinical Gastroenterology,2016,28(2):91-94.[徐杲,苏江,华婷琰,等.内镜黏膜下剥离术及外科手术治疗早期胃癌的预后效果评估[J].临床消化病杂志,2016,28(2):91-94.]
[12] Ye CR,Fu XY. The clinical efficacy comparison of the endoscopic submucosal dissection surgery comparing with the laparoscopic surgery in the treatment of early gastric cancer[J]. Chinese Journal of Clinical Gastroenterology,2017,29(1):11-13.[叶春荣,付肖岩.内镜黏膜下剥离术与腹腔镜手术治疗早期胃癌的临床疗效比较研究[J].临床消化病杂志,2017,29(1):11-13.]
[13] Zhu JY. Comparison of endoscopic submucosal dissection with radical surgery for treatment of early gastric cancer[D].Jinan:Shandong University,2017.[朱靖宇.内镜黏膜下剥离术与外科手术治疗胃早癌的综合疗效对比[D].济南:山东大学,2017.]
[14] Zheng XL,Xiang XZ. Clinical efficacy of endoscopic submucosal dissection and surgical treatment for early gastric cancer[J]. Journal of Critical Care in Internal Medicine,2016,22(5):338-339,357.[郑晓丽,向兴朝.内镜黏膜下剥离术与外科手术治疗早期胃癌的临床研究[J].内科急危重症杂志,2016,22(5):338-339,357.]
[15] Wu YX. Clinical research of the value of endoscopic submucosal dissection for early gastric cancer[D].Hefei:Anhui Medical University,2012.[吴义先.内镜黏膜下剥离术治疗早期胃癌的临床研究[D].安徽:安徽医科大学,2012.]
[16] Yao ZD,Xu G,Wang R,et al. Clinical analysis of 137cases of early gastric cancer in ESD and sur ical operatio[J]. Chinese Journal of Integrated Traditional and Western Medicine on Digestion,2016,24(10):754-757,761.[姚镇东,徐刚,万荣,等.内镜下黏膜剥离术及外科手术治疗137例早期胃癌的临床分析[J].中国中西医结合消化杂志,2016,24(10):754-757,761.]
[17] You Y,Guo XF. Research on endoscopic submucosal dissection for treatment of early gastric cancer and precancerous lesion in Xinjiang area[J]. Southwest National Defense Medicine,2015,25(9):957-959.[游云,郭现芳.新疆地区ESD治疗早期胃癌及癌前病变的研究[J].西南国防医药,2015,25(9):957-959.]
[18] Peng ZH. Analysis on effectiveness and feasibility of endoscopic submucosal dissection for early gastric cancer[J].Modern Journal of Integrated Traditional Chinese and Western Medicine,2015,24(27):2986-2988.[彭志华.早期胃癌行内镜黏膜下剥离术的有效性与可行性分析[J].现代中西医结合杂志,2015,24(27):2986-2988.]
[19] Liu X,Dou LZ,Xue LY,et al. Comparative analysis for clinical efficacy and life quality between endoscopic submucosal dissection and surgical treatment of patients with early gastric cancer[J]. Chinese Journal of Digestive Endoscopy,2017,34(8):543-548.[刘晓,窦利州,薛丽燕,等.早期胃癌内镜黏膜下剥离术与外科手术临床效果及生存质量的回顾性对比研究[J].中华消化内镜杂志,2017,34(8):543-548.]
[20] Sun Y. Endoscopic submucosal dissection comparedwith surgery for treatment of early gastric cancer[D]. Lanzhou:Lanzhou University,2016.[孙洋.内镜粘膜下剥离术与外科手术治疗早期胃癌的对比研究[D].兰州:兰州大学,2016.]
[21] Rong L,Cai YL,Nian WD,et al.Efficacy comparison between surgical resection and endoscopic submucosal dissection of early gastric cancer in a domestic single center[J]. Chinese Journal of Gastrointestinal Surgery,2018,2(21):190-195.[戎龙,蔡云龙,年卫东,等.国内单中心早期胃癌外科切除与内镜黏膜下剥离术疗效比较[J].中华胃肠外科杂志,2018,21(2):190-195.]
[22] Song WC,Qiao XL,Gao XZ. A comparison of endoscopic submucosal dissection(ESD)and radical surgery for early gastric cancer:a retrospective study[J]. World J Surg Oncol,2015,13:309.
[23] Xu Y,Shen L,Lu Z,et al. Concomitant stromal tumor and early cancer of the stomach:what should be done?[J].Medicine(Baltimore),2017,96(29):e7576.
[24] Matsui N,Akahoshi K,Nakamura K,et al. Endoscopic submucosal dissection for removal of superficial gastrointestinal neoplasms:a technical review[J]. World J Gastrointest Endosc,2012,4(4):123-36.
[25] Kamiya T,Joh T,Sollano JD,et al. Consensus of the present and prospects on endoscopic diagnosis and treatment in East Asian countries[J]. Diagn Ther Endosc,2012,2012:808365.
[26] Akasaka T,Nishida T,Tsutsui S,et al. Short-term outcomes of endoscopic submucosal dissection(ESD)for early gastric neoplasm:multicenter survey by Osaka University ESD study group[J]. Dig Endosc,2011,1(23):73-77.
[27] Park YM,Cho E,Kang HY,et al. The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer:a systematic review and metaanalysis[J]. Surg Endosc,2011,8(25):2666-2677.
[28] Hu J,Zhao Y,Ren M,et al. The comparison between endoscopic submucosal dissection and surgery in gastric cancer:a systematic review and Meta-analysis[J]. Gastroenterol Res Pract,2018,2018:4378945.
[29] Zhong C,Yang JY,Li QR,et al. Endoscopic submucosal dissection and gastrectomy for early gastric cancer:a Meta-analysis[J]. China Journal of Endoscopy,2017,23(5):57-63.[钟超,杨建宇,李启睿,等.内镜黏膜下剥离术与外科手术治疗早期胃癌的有效性及安全性的Meta分析[J].中国内镜杂志,2017,23(5):57-63.]
[30] Zhao F,Yang JM,Xu QS,et al. Effectiveness and safety of endoscopic submucosal dissection and surgical treatment of gastrointestinal cancer:a meta-analysis[J]. China Journal of Endoscopy,2014,20(9):912-918.[赵飞,杨建民,徐启顺,等.早期消化道肿瘤内镜黏膜下剥离术和外科手术治疗的有效性和安全性Meta分析[J].中国内镜杂志,2014,20(9):912-918.]
[31] Shuster JJ. Review:Cochrane handbook for systematic reviews for interventions[J]. Res Synth Methods,2011,2(2):126-130.
[32] Wang D,Zhai JX,Mou ZY,et al. Discussing on the research of heterogeneity in Meta-analysis[J]. Chinese Journal of Evidence-Based Medicine,2009,9(10):1115-1118.[王丹,翟俊霞,牟振云,等. Meta分析中的异质性及其处理方法[J].中国循证医学杂志,2009,9(10):1115-1118.]
[2] Ferlay J,Shin HR,Bray F,et al. Estimates of worldwide burden of cancer in 2008:GLOBOCAN 2008[J]. Int J Cancer,2010,12(127):2893-2917.
[3] Ferlay J,Soerjomataram I,Dikshit R,et al. Cancer incidence and mortality worldwide:sources,methods and major patterns in GLOBOCAN 2012[J]. Int J Cancer,2015,5(136):E359-E386.
[4] Barbour AP,Rizk NP,Gerdes H,et al. Endoscopic ultrasound predicts outcomes for patients with adenocarcinoma of the gastroesophageal junction[J]. J Am Coll Surg,2007,4(205):593-601.
[5] Liu GD,Li XB,Li ChR,et al. Updates on lymph node metastasis in early gastric cancer[J]. Chinese Journal of Digestive Surgery,2016,15(1):93-96.[刘国栋,李晓波,李昌荣,等.早期胃癌淋巴结转移的研究进展[J].中华消化外科杂志,2016,15(1):93-96.]
[6] Li YL. Pathology[M]. 8th ed.Beijing:People’s Health Publishing House,2013.[李玉林.病理学[M].第8版.北京:人民卫生出版社,2013.]
[7] Mantel N,Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease[J]. J Natl Cancer Inst,1959,4(22):719-748.
[8] Higgins JP,Thompson SG. Quantifying heterogeneity in a meta-analysis[J]. Stat Med,2002,11(21):1539-1558.
[9] Song F,Gilbody S. Bias in meta-analysis detected by a simple,graphical test. Increase in studies of publication bias coincided with increasing use of meta-analysis[J].BMJ,1998,7129(316):471.
[10] Shi DM,Shao HG. Comparative analysis of the clinical effects of ESD and conventional surgical treatment for EGC patients[J]. Oncology Progress,2017,15(7):777-779.[时冬梅,邵红刚. ESD与传统手术治疗早期胃癌患者的临床效果对比分析[J].癌症进展,2017,15(7):777-779.]
[11] Xu G,Su J,Hua TY,et al. Evaluation of efficacy and prognosis of endoscopic submucosal dissection and traditional surgery for early gastric cancer[J]. Chinese Journal of Clinical Gastroenterology,2016,28(2):91-94.[徐杲,苏江,华婷琰,等.内镜黏膜下剥离术及外科手术治疗早期胃癌的预后效果评估[J].临床消化病杂志,2016,28(2):91-94.]
[12] Ye CR,Fu XY. The clinical efficacy comparison of the endoscopic submucosal dissection surgery comparing with the laparoscopic surgery in the treatment of early gastric cancer[J]. Chinese Journal of Clinical Gastroenterology,2017,29(1):11-13.[叶春荣,付肖岩.内镜黏膜下剥离术与腹腔镜手术治疗早期胃癌的临床疗效比较研究[J].临床消化病杂志,2017,29(1):11-13.]
[13] Zhu JY. Comparison of endoscopic submucosal dissection with radical surgery for treatment of early gastric cancer[D].Jinan:Shandong University,2017.[朱靖宇.内镜黏膜下剥离术与外科手术治疗胃早癌的综合疗效对比[D].济南:山东大学,2017.]
[14] Zheng XL,Xiang XZ. Clinical efficacy of endoscopic submucosal dissection and surgical treatment for early gastric cancer[J]. Journal of Critical Care in Internal Medicine,2016,22(5):338-339,357.[郑晓丽,向兴朝.内镜黏膜下剥离术与外科手术治疗早期胃癌的临床研究[J].内科急危重症杂志,2016,22(5):338-339,357.]
[15] Wu YX. Clinical research of the value of endoscopic submucosal dissection for early gastric cancer[D].Hefei:Anhui Medical University,2012.[吴义先.内镜黏膜下剥离术治疗早期胃癌的临床研究[D].安徽:安徽医科大学,2012.]
[16] Yao ZD,Xu G,Wang R,et al. Clinical analysis of 137cases of early gastric cancer in ESD and sur ical operatio[J]. Chinese Journal of Integrated Traditional and Western Medicine on Digestion,2016,24(10):754-757,761.[姚镇东,徐刚,万荣,等.内镜下黏膜剥离术及外科手术治疗137例早期胃癌的临床分析[J].中国中西医结合消化杂志,2016,24(10):754-757,761.]
[17] You Y,Guo XF. Research on endoscopic submucosal dissection for treatment of early gastric cancer and precancerous lesion in Xinjiang area[J]. Southwest National Defense Medicine,2015,25(9):957-959.[游云,郭现芳.新疆地区ESD治疗早期胃癌及癌前病变的研究[J].西南国防医药,2015,25(9):957-959.]
[18] Peng ZH. Analysis on effectiveness and feasibility of endoscopic submucosal dissection for early gastric cancer[J].Modern Journal of Integrated Traditional Chinese and Western Medicine,2015,24(27):2986-2988.[彭志华.早期胃癌行内镜黏膜下剥离术的有效性与可行性分析[J].现代中西医结合杂志,2015,24(27):2986-2988.]
[19] Liu X,Dou LZ,Xue LY,et al. Comparative analysis for clinical efficacy and life quality between endoscopic submucosal dissection and surgical treatment of patients with early gastric cancer[J]. Chinese Journal of Digestive Endoscopy,2017,34(8):543-548.[刘晓,窦利州,薛丽燕,等.早期胃癌内镜黏膜下剥离术与外科手术临床效果及生存质量的回顾性对比研究[J].中华消化内镜杂志,2017,34(8):543-548.]
[20] Sun Y. Endoscopic submucosal dissection comparedwith surgery for treatment of early gastric cancer[D]. Lanzhou:Lanzhou University,2016.[孙洋.内镜粘膜下剥离术与外科手术治疗早期胃癌的对比研究[D].兰州:兰州大学,2016.]
[21] Rong L,Cai YL,Nian WD,et al.Efficacy comparison between surgical resection and endoscopic submucosal dissection of early gastric cancer in a domestic single center[J]. Chinese Journal of Gastrointestinal Surgery,2018,2(21):190-195.[戎龙,蔡云龙,年卫东,等.国内单中心早期胃癌外科切除与内镜黏膜下剥离术疗效比较[J].中华胃肠外科杂志,2018,21(2):190-195.]
[22] Song WC,Qiao XL,Gao XZ. A comparison of endoscopic submucosal dissection(ESD)and radical surgery for early gastric cancer:a retrospective study[J]. World J Surg Oncol,2015,13:309.
[23] Xu Y,Shen L,Lu Z,et al. Concomitant stromal tumor and early cancer of the stomach:what should be done?[J].Medicine(Baltimore),2017,96(29):e7576.
[24] Matsui N,Akahoshi K,Nakamura K,et al. Endoscopic submucosal dissection for removal of superficial gastrointestinal neoplasms:a technical review[J]. World J Gastrointest Endosc,2012,4(4):123-36.
[25] Kamiya T,Joh T,Sollano JD,et al. Consensus of the present and prospects on endoscopic diagnosis and treatment in East Asian countries[J]. Diagn Ther Endosc,2012,2012:808365.
[26] Akasaka T,Nishida T,Tsutsui S,et al. Short-term outcomes of endoscopic submucosal dissection(ESD)for early gastric neoplasm:multicenter survey by Osaka University ESD study group[J]. Dig Endosc,2011,1(23):73-77.
[27] Park YM,Cho E,Kang HY,et al. The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer:a systematic review and metaanalysis[J]. Surg Endosc,2011,8(25):2666-2677.
[28] Hu J,Zhao Y,Ren M,et al. The comparison between endoscopic submucosal dissection and surgery in gastric cancer:a systematic review and Meta-analysis[J]. Gastroenterol Res Pract,2018,2018:4378945.
[29] Zhong C,Yang JY,Li QR,et al. Endoscopic submucosal dissection and gastrectomy for early gastric cancer:a Meta-analysis[J]. China Journal of Endoscopy,2017,23(5):57-63.[钟超,杨建宇,李启睿,等.内镜黏膜下剥离术与外科手术治疗早期胃癌的有效性及安全性的Meta分析[J].中国内镜杂志,2017,23(5):57-63.]
[30] Zhao F,Yang JM,Xu QS,et al. Effectiveness and safety of endoscopic submucosal dissection and surgical treatment of gastrointestinal cancer:a meta-analysis[J]. China Journal of Endoscopy,2014,20(9):912-918.[赵飞,杨建民,徐启顺,等.早期消化道肿瘤内镜黏膜下剥离术和外科手术治疗的有效性和安全性Meta分析[J].中国内镜杂志,2014,20(9):912-918.]
[31] Shuster JJ. Review:Cochrane handbook for systematic reviews for interventions[J]. Res Synth Methods,2011,2(2):126-130.
[32] Wang D,Zhai JX,Mou ZY,et al. Discussing on the research of heterogeneity in Meta-analysis[J]. Chinese Journal of Evidence-Based Medicine,2009,9(10):1115-1118.[王丹,翟俊霞,牟振云,等. Meta分析中的异质性及其处理方法[J].中国循证医学杂志,2009,9(10):1115-1118.]