非典型脑膜瘤患者无进展生存期影响因素的Meta分析

A meta-analysis of the influencing factors of progression-free survival in patients with atypical meningioma

目的系统分析影响非典型脑膜瘤(AM)患者无进展生存期(PFS)的相关因素。方法检索PubMed、Cochrane library、Medline、中国知网、维普、万方等数据库中关于AM患者术后预后的相关文献,检索时限为建库至2019年10月31日。将符合标准的文献纳入研究,提取的分析指标包括:年龄、性别、术前Karnofsky功能状态评分(KPS)、肿瘤位置和直径、肿瘤是否侵袭颅骨和脑组织、肿瘤切除程度、肿瘤细胞增殖情况及术后是否放疗。采用纽斯卡尔-渥太华文献质量评分量表(NOS)评价纳入文献的质量。利用Stata 14.0统计软件分析影响AM患者PFS的相关因素。结果共纳入18篇文献,总计2613例患者,纳入文献的NOS评分为6~8分。Meta分析结果显示,KPS(HR=0.48,95%CI:0.38~0.60,P<0.001)、肿瘤侵袭脑组织(HR=1.56,95%CI:1.23~1.98,P<0.001)及术后放疗(HR=0.58,95%CI:0.46~0.73,P<0.001)是影响AM患者PFS的因素。结论影响AM患者PFS的相关因素较多,其中低KPS和肿瘤侵袭脑组织的患者复发风险较高,放疗有助于延长患者术后的PFS;其他因素尚待大样本长期随访研究进一步证实。

Objective To systematically analyze the factors related to the progression-free survival(PFS)of patients with atypical meningioma(AM).Methods Literatures regarding postoperative outcomes of AM were searched in the databases of PubMed,Cochrane Library,Medline,CNKI,VIP and WanFang.The time window of literatures searched was from the establishment of the database to October 31,2019.Based on the inclusion and exclusion criteria,the literatures meeting the criteria were included in the study,and the analytical indicators extracted included:age,sex,preoperative Karnofsky Functional Status(KPS)score,tumor location and diameter,whether the tumor invaded the skull and brain,tumor resection degree,tumor cell proliferation and postoperative radiotherapy.The quality of the literature included was evaluated using the Newcastle-Ottawa Literature Quality Rating Scale(NOS).Stata 14.0 statistical software was used to analyze the relevant factors affecting PFS in AM patients.Results A total of 18 papers involving 2613 patients were included in the study,and the NOS scores were 6-8.The meta-analysis showed that KPS score(HR=0.48,95%CI:0.38-0.60,P<0.001),brain invasion of tumor(HR=1.56,95%CI:1.23-1.98,P<0.001)and postoperative radiotherapy(HR=0.58,95%CI:0.46-0.73,P<0.001)were factors affecting the PFS of AM.Conclusions There are multiple factors affecting the PFS in AM patients,among which low KPS score and brain invasion of tumor are associated with relatively higher risk of recurrence,and radiotherapy seems to prolong PFS post surgery.Other factors have yet to be further confirmed by long-term follow-up studies of large samples.