Background: Granulocyte-colony stimulating factor (G-CSF) prophylaxis is widely used in gastrointestinal (GI) cancers. The use of G-CSF in GI cancers has not previously been investigated systematically in a meta-analysis. Thus, we systematically reviewed the literature to describe the G-CSF use and potential influence on long-term oncological outcomes in GI cancers. Method: The literature search of this systematic review and meta-analysis was conducted in PubMed, Embase, Cochrane Library and Web of Science. The PRISMA-P guidelines were followed. Studies that reported data on patients with GI cancers undergoing oncological treatment with G-CSF prophylaxis were included. Outcomes of interest were overall survival (OS), progression-free survival (PFS) and adverse events (AE), specifically neutropenia grade III/IV. A time-to-event random-effects meta-analysis was conducted. Risk of bias was assessed using the Newcastle–Ottawa Scale and the Cochrane Risk of Bias Tool for Randomized Controlled Trials (RoB) tool. Findings: In total, 2452 articles were screened for eligibility. Ultimately, 13 studies were included with a total patient number of 2673. The included studies indicated a positive association between OS and G-CSF prophylaxis (HR 0.72, 95% CI: 0.56–0.91,I2: 54%, low quality evidence). No significant relation between G-CSF use and PFS was found in the pooled analyses (HR 0.74, 95% CI: 0.51–1.08,I2: 73%, moderate quality evidence). However, a positive effect of G-CSF use was found in the retrospective cohorts reporting data on PFS (HR 0.50, 95% CI: 0.32–0.77,I2: 0%). A marked drop in neutropenia grade III/IV rates was observed in patients treated with G-CSF (risk ratio (RR) 0.46, 95% CI: 0.28–0.77,I2: 72%, high quality evidence). Interpretation: G-CSF prophylaxis provides a reduction in neutropenia grade III/IV in patients with GI cancers (high level of certainty) and a favorable OS (low certainty), while PFS is unaffected (moderate certainty). Studies on PFS and G-CSF use are nonetheless limited.
背景：粒细胞集落刺激因子（G-CSF）预防性治疗在胃肠道（GI）癌症中应用广泛。此前尚未有荟萃分析对G-CSF在胃肠道癌症中的应用进行系统性研究。因此，我们系统回顾了相关文献，以描述G-CSF在胃肠道癌症中的使用情况及其对长期肿瘤学结局的潜在影响。 方法：本系统综述与荟萃分析的文献检索在PubMed、Embase、Cochrane Library和Web of Science数据库中进行，遵循PRISMA-P指南。纳入报告接受G-CSF预防性治疗的胃肠道癌症患者数据的研究。关注结局包括总生存期（OS）、无进展生存期（PFS）和不良事件（AE），特别是III/IV级中性粒细胞减少症。采用时间-事件随机效应模型进行荟萃分析，使用纽卡斯尔-渥太华量表和Cochrane随机对照试验偏倚风险评估工具（RoB）评估偏倚风险。 结果：共筛选2452篇文章，最终纳入13项研究，总计2673例患者。纳入研究表明OS与G-CSF预防性治疗呈正相关（HR 0.72，95% CI：0.56–0.91，I²：54%，证据质量低）。汇总分析未发现G-CSF使用与PFS存在显著关联（HR 0.74，95% CI：0.51–1.08，I²：73%，证据质量中等）。然而，在报告PFS数据的回顾性队列研究中发现G-CSF使用具有积极效应（HR 0.50，95% CI：0.32–0.77，I²：0%）。接受G-CSF治疗的患者III/IV级中性粒细胞减少症发生率显著降低（风险比（RR）0.46，95% CI：0.28–0.77，I²：72%，证据质量高）。 结论：G-CSF预防性治疗可降低胃肠道癌症患者的III/IV级中性粒细胞减少症发生率（证据确定性高），并改善总生存期（证据确定性低），而对无进展生存期无影响（证据确定性中等）。但关于PFS与G-CSF使用的研究仍有限。
肿瘤(癌症)患者之家