| BackgroundThe incidence of primary gastrointestinal lymphoma has been increasingly raised in recent years.As one of the most common primary malignant lymphoma outside lymph nodes,because of the difference compared with conventional lymphoma in the clinical symptom and pathogenesis,the diagnosis and treatment of primary gastrointestinal lymphoma has been changed in the past few decades.Surgery considered as the main approach of the original diagnosis has been gradually replaced by endoscopy and C T.Along with the deeply research,an ocean of investigations have confirmed that the operation co mpared with chemotherapy in treatment of primary gastric lymphoma could not improve overall survival and disease-free survival of patients.Due to the distinctions of the pathogenesis and pathological types,there are exactly different in the treatment of primary intestinal lymphoma and gastric lymphoma.To our knowledge,chemotherapy has been recognized as an effective treatment for primary intestinal lymphoma of most pathological types.However,whether perform surgery has not come to an agreement for primary intestinal lymphoma.Therefore,we will perform Meta-analysis and draw conclusions for the above controversial issue through present experimental studies.ObjectiveWe aim to systemically compare and evaluate the advantages and disadvantages between the two therapies of surgical resection followed by chemotherapy and chemotherapy alone for primary intestinal lymphoma.Material and MethodsPublicly published papers associated with English and C hinese all clinical controlled trials on surgical resection followed by chemotherapy and chemotherapy alone for primary intestinal lymphoma were identified by systemically searching in medical databases of CNKI,WANFANG,Pub Med,Cochrane Library and Embase.The retrieval time was up to December 2015.The main contras t indexes of overall survival(OS)and progression-free survival(PFS)time were compared.According to enrolled and excluded standards,we screened literatures.Subsequently,the enrolled literatures were evaluated and the data which would be analyzed were extracted.Finally,we utilized statistical software,Review Manager 5.2,recommended by Cochrane for Meta analyzing the extracted results.ResultsA total of five retrospective non-randomized controlled research were incorporated analysis involving 365 patients conform to the criteria,including 167 patients who were offered complete surgical resection combined with chemotherapy,167 patients performed incomplete surgical resection combined with chemotherapy and 147 cases only given chemotherapy.The results of Meta-analysis revealed that(1)3-year overall survival(RR=1.54,95%CI:1.30-1.82,P<0.00001),5-year overall survival(RR=1.63,95%CI:1.09-2.43,P=0.02)and progression-free survival of 3-year(RR=1.66,95%CI:1.31-2.08,P<0.00001)in complete surgical resection group were superior to that of patients in pure chemotherapy.(2)There was no significant difference in the index of the 3-year overall survival(RR=1.39,95% CI:0.96-2.01,P=0.08)and 5-year overall survival(RR=1.05,95%CI:0.45-2.48,P=0.90)between the groups of incomplete surgical resection and chemotherapy alone.However,compared with the chemotherapy group,progression-free survival of 3-year was superior in the group of incomplete surgical resection combined with chemotherapy.ConclusionsIn order to cure stage?and? of primary intestinal lymphoma,we recommend to the therapy of complete surgical resection followed by chemotherapy,so that the patients could strive for longer overall survival and progression-free survival.For the stage ? and ? of primary intestinal lymphoma,only when patients occurred intestinal complications,incomplete surgical resection would act as a n effective mean. |
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