Abstract / Summary
Objective: To systematically evaluate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) versus surgical resection for early gastric cancer (EGC) in patients aged 75 years and above. Methods: A systematic search was conducted in PubMed, Embase, Cochrane Library, and CNKI from the inception of the database to April 2026, to include relevant literature on ESD and surgery for aged 75 years and above patients with EGC. The experimental group consisted of patients aged≥75 years treated with ESD (ESD group), while the control group included those treated with surgery (surgery group). According to inclusion and exclusion criteria, two researchers independently performed literature screening, data extraction using the Newcastle-Ottawa Scale, and conducted meta-analysis using RevMan 5.4 and Stata 18.0 software to assess heterogeneity using I2. Outcome measures included the 5-year survival rate, recurrence rate, recurrence-related mortality rate, and tumor incidence rates across different mucosal layers in both groups of patients. Funnel plots and leave-one-out analysis were adopted for publication bias analysis and sensitivity analysis. Results: A total of 6 studies involving 2 045 patients were included, with 988 in the ESD group and 1 057 in the control group. The 5-year survival rate (82.9% vs 77.4%, OR=1.29, 95%CI: 1.01-1.65, P=0.040, I2=0) and gastric cancer recurrence rate (8.5% vs 4.3%, OR=2.39, 95%CI: 1.37-4.14, P=0.002, I2=24%) were higher in the ESD group than those in the surgical group, whereas the recurrence-related mortality rate was lower in the ESD group (1.9% vs 4.9%, OR=0.47, 95%CI: 0.25-0.86, P=0.020, I2=34%). Subgroup analysis by tumor incidence rates across different mucosal layers showed that the proportion of mucosal tumors was higher in the ESD group than that in the surgical group (78.8% vs 38.3%, OR=3.40, 95%CI: 1.15-10.07, P=0.030, I2=95%), whereas the proportion of submucosal tumors was lower in the ESD group than in the surgical group (20.7% vs 61.4%, OR=0.29, 95%CI: 0.10-0.87, P=0.030, I2=95%). Funnel plot analysis showed that the studies were generally symmetrically distributed on both sides of the pooled effect size (log OR), forming an inverted funnel shape; sensitivity analysis demonstrated that the point estimates of individual studies fluctuated slightly around the original pooled effect size (log OR=1.05). Conclusion: For EGC patients aged 75 years and above, ESD demonstrates superior clinical efficacy and safety compared to surgical treatment. 目的： 系统评价内镜黏膜下剥离术（ESD）与外科手术治疗75岁及以上早期胃癌（EGC）患者的临床疗效及安全性。 方法： 系统检索PubMed、Embase、Cochrane Library、中国知网数据库，检索时限为建库至2026年4月，纳入采用ESD与外科手术治疗75岁及以上EGC患者的相关文献。试验组（ESD组）为采用ESD治疗75岁及以上EGC患者，对照组（外科手术组）为采用外科手术治疗75岁及以上EGC患者。2名研究者按照纳入与排除标准独立筛选文献和提取资料，采用纽卡斯尔-渥太华量表评估纳入文献的质量，应用RevMan 5.4和Stata 18.0软件进行meta分析，以I2评估异质性。结局指标为两组患者的5年生存率、胃癌复发率、复发相关致死率及不同黏膜层面的肿瘤发生率。采用漏斗图和逐一剔除法进行发表偏倚分析与敏感性分析。 结果： 共纳入6篇文献2 045例患者，其中ESD组988例，对照组1 057例。ESD组5年生存率（82.9%比77.4%，OR=1.29，95%CI：1.01~1.65，P=0.040，I2=0）、胃癌复发率（8.5%比4.3%，OR=2.39，95%CI：1.37~4.14，P=0.002，I2=24%）均高于外科手术组；复发相关致死率低于外科手术组（1.9%比4.9%，OR=0.47，95%CI：0.25~0.86，P=0.020，I2=34%）。不同黏膜层面的肿瘤发生率的亚组分析显示，ESD组黏膜层肿瘤发生率高于外科手术组（78.8%比38.3%，OR=3.40，95%CI：1.15~10.07，P=0.030，I2=95%）；而黏膜下层肿瘤发生率低于外科手术组（20.7%比61.4%，OR=0.29，95%CI：0.10~0.87，P=0.030，I2=95%）。漏斗图提示各研究在合并效应量（log OR）两侧整体基本对称分布，呈倒漏斗状分布；敏感性分析显示各研究的效应点估计值均在合并效应量（log OR=1.05）附近微幅波动。 结论： 对于75岁及以上EGC患者，ESD治疗的疗效及安全性优于外科手术。.