Abstract Background Patients with small intestinal neuroendocrine tumours (siNETs) usually present with advanced disease. Primary tumour resection without curative intent is controversial in patients with metastatic siNETs. The aim of this meta-analysis was to investigate survival after primary tumour resection without curative intent compared with no resection in patients with metastatic siNETs. Methods A systematic literature search was performed, using MEDLINE® (PubMed), Embase®, Web of Science, and the Cochrane Library up to 25 February 2021. Studies were included if survival after primary tumour resection versus no resection in patients with metastatic siNETs was reported. Results were pooled in a random-effects meta-analysis, and are reported as hazard ratios (HRs) with 95 per cent confidence intervals. Sensitivity analyses were undertaken to enable comment on the impact of important confounders. Results After screening 3659 abstracts, 16 studies, published between 1992 and 2021, met the inclusion criteria, with a total of 9428 patients. Thirteen studies reported HRs adjusted for important confounders and were included in the meta-analysis. Median overall survival was 112 (i.q.r. 82–134) months in the primary tumour resection group compared with 60 (74–88) months in the group without resection. Five-year overall survival rates were 74 (i.q.r. 67–77) and 44 (34–45) per cent respectively. Primary tumour resection was associated with improved survival compared with no resection (HR 0.55, 95 per cent c.i. 0.47 to 0.66). This effect remained in sensitivity analyses. Conclusion Primary tumour resection is associated with increased survival in patients with advanced, metastatic siNETs, even after adjusting for important confounders.

中文翻译：

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无治疗目的的原发肿瘤切除术对小肠和右结肠转移性神经内分泌肿瘤患者的效果：荟萃分析

摘要 背景小肠神经内分泌肿瘤 (siNET) 患者通常已处于晚期疾病。对于转移性 siNET 患者，无治疗目的的原发肿瘤切除存在争议。这项荟萃分析的目的是调查转移性 siNET 患者在无治疗目的的原发肿瘤切除后与未切除的情况下的生存率。 方法使用 MEDLINE® (PubMed)、Embase®、Web of Science 和 Cochrane Library 进行了截至 2021 年 2 月 25 日的系统文献检索。如果报告了原发性肿瘤切除后与未切除转移性 siNET 患者的生存率，则纳入研究。结果汇集在随机效应荟萃分析中，并报告为风险比 (HR)，置信区间为 95%。进行了敏感性分析，以便能够对重要混杂因素的影响进行评论。 结果经过筛选 3659 份摘要，1992 年至 2021 年间发表的 16 项研究符合纳入标准，共计 9428 名患者。十三项研究报告了针对重要混杂因素调整的 HR，并纳入荟萃分析。原发肿瘤切除组的中位总生存期为 112 (iqr 82–134) 个月，而未切除组的中位总生存期为 60 (74–88) 个月。五年总生存率分别为 74%（IQR 67-77）和 44%（34-45）。与不切除相比，原发肿瘤切除与生存率提高相关（HR 0.55，95% CI 0.47 至 0.66）。这种影响仍然存在于敏感性分析中。 结论即使在调整了重要的混杂因素后，原发肿瘤切除与晚期转移性 siNET 患者的生存率增加相关。