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Effectiveness of Helicobacter pylori eradication in the treatment of early-stage gastric mucosa-associated lymphoid tissue lymphoma:An up-to-date meta-analysis

查看全文 作　　者：Fabian Fellipe Bueno [1]Lemos;Caroline Tianeze de [2]Castro;Mariana Santos [1]Calmon;Marcel Silva [1]Luz;Samuel Luca Rocha [1]Pinheiro;Clara Faria Souza Mendes dos [1]Santos;Gabriel Lima Correa [1]Santos;Hanna Santos [3]Marques;Henrique Affonso [1]Delgado;Kádima Nayara [4]Teixeira;Cláudio Lima [1]Souza;Márcio Vasconcelos [1]Oliveira;Fabrício Freire de [1]Melo 高影响力作者 机构地区：[1]Instituto Multidisciplinar em Saúde,Universidade Federal da Bahia,Vitória da Conquista 45029094,Bahia,Brazil;[2]Instituto de Saúde Coletiva,Universidade Federal da Bahia,Salvador 40110040,Bahia,Brazil;[3]Campus Vitória da Conquista,Universidade Estadual do Sudoeste da Bahia,Vitória da Conquista 45029094,Bahia,Brazil;[4]Campus Toledo,Universidade Federal do Paraná,Toledo 85919899,Paraná,Brazil高影响力机构 出　　处：《World Journal of Gastroenterology》索引2023年第29卷第14期,共20页高影响力期刊 基　　金：the Scientific Initiation Scholarship Programme (PIBIC) of the Bahia State Research Support Foundation,FAPESB,Brazil;the Doctorate Scholarship Program of the Coordination of Improvement of Higher Education Personnel,CAPES,Brazil;the Scientific Initiation Scholarship Programme (PIBIC) of the National Council for Scientific and Technological Development,CNPq,Brazil;the CNPq Research Productivity Fellowship (PQ) 摘　　要：BACKGROUND Gastric mucosa-associated lymphoid tissue(MALT)lymphoma(GML)is usually a low-grade B-cell neoplasia strongly associated with Helicobacter pylori(H.pylori)-induced chronic gastritis.Clinical practice guidelines currently recommend H.pylori eradication as the preferred initial treatment for early-stage GML.To determine the practical effect of bacterial eradication as the sole initial therapy for early-stage GML,an updated analysis and review of available evidence is imperative.AIM To perform a meta-analysis to assess the rate of complete remission(CR)of H.pylori-positive early-stage GML following bacterial eradication.METHODS We performed independent,computer-assisted literature searches using the PubMed/MEDLINE,Embase,and Cochrane Central databases through September 2022.Prospective and retrospective observational studies evaluating the CR of early-stage GML following bacterial eradication in H.pylori-positive patients.The risk of bias was assessed using Joanna Briggs Institute(JBI)Critical Appraisal Tools.The pooled estimate of the complete histopathological remission rate and respective confidence intervals(95%CI)were calculated following the random-effects model.Heterogeneity and inconsistency were assessed using Cochran’s Q test and I2 statistic,and heterogeneity was defined as P<0.01 and I²>50%,respectively.Subgroup and meta-regression analyses were conducted to explore potential sources of heterogeneity.RESULTS The titles and abstracts of 1576 studies were screened;96 articles were retrieved and selected for full-text reading.Finally,61 studies were included in the proportional meta-analysis(P-MA).Forty-six were prospective and fifteen were retrospective uncontrolled,single-arm,observational studies.The overall risk of bias was low to moderate in all but a single report,with an average critical appraisal score across all studies of 79.02%.A total of 2936 H.pylori-positive early-stage GML patients,in whom H.pylori was successfully eradicated,were included in the analysis.The pooled CR of H.pylori-positive early-stage GML after bacterial eradication was 75.18%(95%CI:70.45%-79.91%).P-MA indicated the substantial heterogeneity in CR reported across studies(I2=92%;P<0.01).Meta-regression analysis identified statistically significant effect modifiers,including the proportion of patients with t(11;18)(q21;q21)-positive GML and the risk of bias in each study.CONCLUSION Comprehensive synthesis of available evidence suggests that H.pylori eradication is effective as the sole initial therapy for early-stage GML.Although the substantial heterogeneity observed across studies limits the interpretation of the pooled overall CR,the present study is a relevant to informing clinical practice. 关 键 词：LYMPHOMA B-CELL Marginal zone Gastric mucosa-associated lymphoid tissue lymphoma Stomach lymphoma Helicobacter pylori THERAPEUTICS Eradication therapy
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