含印戒细胞的胃腺癌的新辅助治疗：系统综述与荟萃分析。
完整摘要 · 中文译文
背景：含印戒细胞的胃癌是一个日益被认识到的亚型。尽管围手术期化疗是局部晚期胃癌的标准治疗，但其在含印戒细胞的胃腺癌中的疗效仍存在争议。本系统综述与荟萃分析旨在评估新辅助化疗与直接手术相比对总生存期的影响。 方法：对MEDLINE、Scopus和Cochrane进行了系统检索，截止至2026年1月。纳入的研究包括接受新辅助化疗后手术与直接胃切除术相比的含印戒细胞胃癌成年患者。采用随机效应荟萃分析合并总生存期的风险比。 结果：共纳入六项研究，包括七个队列和5.388名患者。合并分析显示，新辅助化疗与直接手术之间的总生存期无显著差异（HR 0.96，95% CI 0.68-1.34，I2 = 83.2%）。按研究地理来源和设计进行的亚组分析显示结果一致，西方研究（HR 0.85，95% CI 0.53-1.38，I² = 86.9%）或东方研究（HR 1.12，95% CI 0.63-1.97，I² = 83%）之间以及不同研究设计之间（随机对照试验：HR 1.16，95% CI 0.81-1.67；观察性研究：HR 0.92，95% CI 0.62-1.38，I² = 85.5%）的总生存期均无显著差异。 结论：与直接手术相比，新辅助化疗在含印戒细胞 含印戒细胞的胃癌。虽然围手术期化疗仍是推荐的治疗方法，但仍需采用当代化疗方案开展进一步研究，以明确其在这一独特组织学亚型中的作用。
完整摘要 · 英文原文
BACKGROUND: Signet ring cell-containing gastric cancer constitutes an increasingly recognized subtype. Although perioperative chemotherapy is the standard of treatment for locally advanced gastric cancer, its efficacy in signet ring cell-containing gastric adenocarcinomas remains controversial. This systematic review and meta-analysis aims to assess the impact of neoadjuvant chemotherapy compared to upfront surgery on overall survival. METHODS: A systematic search of MEDLINE, Scopus, and Cochrane was conducted up to January 2026. Eligible studies included adult patients with signet ring cell-containing gastric cancer undergoing neoadjuvant chemotherapy followed by surgery compared to upfront gastrectomy. A random-effects meta-analysis was performed to pool hazard ratios for overall survival. RESULTS: Six studies, including seven cohorts and 5.388 patients, were included. The pooled analysis demonstrated no significant difference in overall survival between neoadjuvant chemotherapy and upfront surgery (HR 0.96, 95% CI 0.68-1.34, I2 = 83.2%). Subgroup analyses by studies' geographic origin and design revealed consistent results with no significant differences in overall survival among Western (HR 0.85, 95% CI 0.53-1.38, I² = 86.9%) or Eastern studies (HR 1.12, 95% CI 0.63-1.97, I² = 83%), and among different study designs (randomized controlled trial: HR 1.16, 95% CI 0.81-1.67; observational: HR 0.92, 95% CI 0.62-1.38, I² = 85.5%). CONCLUSIONS: Neoadjuvant chemotherapy was not associated with a significant improvement in overall survival compared with upfront surgery in signet-ring cell-containing gastric cancer. While perioperative chemotherapy remains the recommended therapeutic approach, further studies employing contemporary chemotherapy regimens are warranted to define its role in this distinct histological subtype.