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复发性胸腺瘤最好治疗方法是什么？系统评价和Meta分析。

已有 2395 次阅读2021-4-14 20:45 |个人分类:TET学习|系统分类:医学科学

复发性胸腺瘤最好治疗方法是什么？系统评价和Meta分析。Which Is the Best Treatment in Recurrent Thymoma? A Systematic Review and Meta-Analysis

背景：由于患者人数有限、相对晚期以及复发方式多变，关于复发性胸腺瘤的最佳治疗仍然存在争议。鉴于缺乏高质量的证据且研究人群相对较少，我们进行了定量Meta分析，以确定手术和非手术方法的结果，以评估复发性胸腺瘤患者的五年总体生存期（5y总体生存期（OS））。

方法：我们根据PRISMA研究指南（1980年1月1日至2020年6月18日从PubMed / MEDLINE，EMBASE和Scopus进行的研究）进行了全面的文献检索和分析。我们纳入了队列超过30位患者的研究，这些患者描述了复发性胸腺瘤的治疗方法，比较了报告生存数据的手术和非手术方法。

结果：文献搜索发现3017篇文章。9项研究符合所有入选标准，并被选择进行Meta分析。局部/局部复发率为73-98％，多发为49-72％。治疗后，5年OS的范围为48-77％，10年OS的范围为37-51％。定量荟萃分析显示，与手术治疗相比，其他治疗效果更好。两项研究表明，在5年OS中，有统计学意义的风险差异有利于完全切除。在使用随机模型汇总7项研究的结果后，合并的5年OS风险差异为0.39，上下限分别为0.16和0.62（p = 0.001），研究之间存在中等程度的异质性（p = 0.098，I2 = 43.9％）。关于重症肌无力、组织学和复发方式对预后的影响，目前的文献尚不能得出明确的结论。

结论：胸腺瘤复发后的手术治疗与5y OS显着改善有关。因此，在所有技术可行的情况下，均应首选手术切除。

关键词：化学疗法；荟萃分析放射治疗;复发性胸腺瘤手术。

Figure 1 PRISMA diagram presenting the literature search and selection showing numbers of articles at each stage.

Background: Optimal recurrent thymoma management remains arguable because of limited patient numbers, and relatively late and variable recurrence patterns. Given the absence of high-quality evidence and relatively small study cohorts, we performed a quantitative meta-analysis to determine the outcome of surgical and non-surgical approaches assessing the five-year overall survival (5y overall survival (OS)) in patients with recurrent thymoma.

Methods: We performed a comprehensive literature search and analysis according to PRISMA guidelines of studies published from 1 January 1980 until 18 June 2020 from PubMed/MEDLINE, EMBASE, and Scopus. We included studies with the cohorts' superior to 30 patients describing recurrent thymoma treatment, comparing surgical and non-surgical approaches reporting survival data.

Results: Literature search revealed 3017 articles. Nine studies met all inclusion criteria and were se lected for the meta-analysis. The recurrences were local/regional in 73-98% of cases and multiple in 49-72%. After treatment, 5y OS ranged from 48-77% and 10y OS from 37-51%. The quantitative meta-analysis showed a better outcome comparing surgical vs other treatments. Two studies showed statistically significant risk differences in the 5y OS favoring complete resection. After pooling results of seven studies using the random model, the combined 5y OS risk difference was 0.39, with lower and upper limits of 0.16 and 0.62, respectively (p = 0.001), and a moderate heterogeneity among studies (p = 0.098, I2 = 43.9%). Definitive conclusions could not be drawn regarding the prognostic impact of myasthenia gravis, histology, and patterns of relapse reported in literature.

Conclusions: Surgical treatment after thymoma recurrence is associated with a significant better 5y OS; therefore, surgical resection should be preferred in all technically feasible cases.

Keywords: chemotherapy; meta-analysis; radiation therapy; recurrent thymoma; surgery.

Chiappetta M, Grossi U, Sperduti I, Margaritora S, Marulli G, Fiorelli A, Sandri A, Mizuno T, Cusumano G, Hamaji M, Cesario A, Lococo F. Which Is the Best Treatment in Recurrent Thymoma? A Systematic Review and Meta-Analysis. Cancers (Basel). 2021 Mar 29;13(7):1559. doi: 10.3390/cancers13071559. PMID: 33805310; PMCID: PMC8036834.