A Meta-analysis About The Effectiveness Of Surgical Resection Versus Chemotherapy In Treatment With Primary Gastrointestinal Lymphoma

Objective: To evaluate the effectiveness and safety of two regimens represented by systemic treatment based on surgical resection and conservative treatment based on chemotherapy for primary gastrointestinal lymphoma.Methods:Meta-analysis is used, searching studies in Pub-Med, Ovid, Springer, NCBI,Wan Fang and other public retrieval systems from the time of database established to2014-12-30, and also retrieving unpublished literature or conference papers through other ways. We select randomized clinical trials(RCT) and the prospective controlled trials(PNR) about the treatment of patient with PGIL who accepted operation(associated with chemotherapy and /or radiotherapy) and chemotherapy alone(or associated radiotherapy), then evaluate the quality of each study included and extract the relevant data.Primary interests were:overall survival(OS) and disease-free survival(DFS), the secondary ones were relapse, mortality related treatment and the complications(gastrointestinal tract bleeding, perforation and injection). Rev Man5.2 and stata11.0 was used for Meta-analysis.Results: There’re 6 studies included 1 RCT and 5 PNR studies, 725 cases whom 370 people received surgery( or associated with chemotherapy/radiotherapy) and 355 people received chemotherapy( or associated with radiotherapy). The results of the meta-analysis show that:(1) there’s no difference in the effect of OS(OR=0.55, 95%CI:0.23-1.29, P=0.17), but DFS(OR=6.60, 95%CI: 6.99-14.60, P<0.00001) is significantly better in chemotherapy(or associated with radiotherapy);(2)The risk of injection(OR=0.31, 95%CI: 0.13-0.77, P=0.006) in chemotherapy(or associated with radiotherapy)is higher;(3)For perforation and bleeding(P=0.89), relapse(P=0.21), death related treatment(P=0.41), complete remission( P=0.54), the effect of two strategies is not statistically significant.Conclusion: The treatment based on operation can’t increase the survival rate of patients with PGIL, we recommend conservative treatment based on chemotherapy as the primary choice for patients with PGIL in the clinical.