胸腺瘤完整切除术后辅助放疗有效性的Meta分析

A Meta-analysis on Effects of Postoperative Radiotherapy after Radical Resection of Thymoma

目的系统评价术后辅助放疗对胸腺瘤完整切除患者的有效性。方法计算机检索MEDLINE、EMbase、Pub Med、中国知网、维普数据库、万方数据库和The Cochrane Library数据库,检索时限均为从建库至2015年8月,纳入有关术后辅助放疗治疗胸腺瘤的文献。由两名研究者按照纳入与排除标准独立筛选文献、提取资料和评价文献质量后,采用Rev Man 5.3软件进行Meta分析。结果共纳入14个研究,3 823例患者,其中2 096例患者接受了术后辅助放疗,1 727例患者只接受了胸腺完整切除术。Meta分析结果显示:相对于单纯行胸腺瘤完整切除术的患者,术后辅助放疗未提高明显患者的总体生存率(OS)[HR=0.99,95%CI 0.87~1.13,P=0.87]、无病生存率[HR=1.21,95%CI 0.97~1.51,P=0.09]和疾病特异生存率[HR=0.66,95%CI 0.39~1.13,P=0.13];但亚组分析显示,在提高患者OS方面,对于Ⅱ期和Ⅲ期胸腺瘤患者,术后辅助放疗可使患者获益,HR和95%CI分别为0.57,0.41~0.80(P=0.001)和0.73、0.59~0.90(P=0.004)。结论胸腺瘤完整切除术后辅助放疗可提高Ⅱ期和Ⅲ期胸腺瘤患者的OS。

Objective To systematically evaluate the efficacy of postoperative radiotherapy in patients with completely resected thymoma. Methods Literature about the efficacy of postoperative radiotherapy in patients with completely resected thymoma were searched from digital databases of MEDLINE,EMbase,Pub Med,CNKI,VIP,Wan Fang Data and The Cochrane Library from their establishment dates to August 2015. Data extraction and quality assessment of included studies were conducted by two reviewers independently. Rev Man 5. 3 software was then used to perform Meta-analysis. Results A total of 14 studies involving 3 823 patients（ 2 096 patients who received postoperative radiotherapy and 1 727 patients who did not receive postoperative radiotherapy） were included in the analysis. The results of Meta-analysis showed that,thymoma patients who receive postoperative radiotherapy did not have significantly improved overall survial（ OS）（ HR = 0. 99,95% CI0. 87-1. 13,P = 0. 87）,disease-free survival（ HR = 1. 21,95% CI 0. 97-1. 51,P = 0. 09）,or disease specific survival（ HR =0. 66,95% CI 0. 39-1. 13,P = 0. 13） compared with the patients who did not undergo postoperative radiotherapy. However,our subgroup analysis showed a significant difference in OS in patients with stageⅡthymoma（ HR = 0. 57,95% CI 0. 41-0. 80,P =0. 001） and patients with stage Ⅲ thymoma（ HR = 0. 73,95% CI 0. 59-0. 90,P = 0. 004）. Conclusion In the aspect of OS,the postoperative radiotherapy is beneficial to the patients with stage Ⅱ and Ⅲ thymoma after a complete resection.