早期小细胞肺癌术后胸内放射治疗预后价值的Meta分析

Meta-analysis of prognostic value of intrathoracic radiotherapy for early small cell lung cancer

目的:通过Meta分析探究术后辅助化疗联合胸内照射对于早期小细胞肺癌(small cell lung cancer,SCLC)的预后价值。方法:采用主题词和关键词相结合的检索方法,检索Pubmed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、万方数据库和中国知网数据库从建库至2020年08月20日发表的比较SCLC术后辅助胸内放疗的文献。主要研究终点为总生存时间(overall survival,OS),次要研究终点为无病生存时间(disease-free survival,DFS);是否术后胸内照射同OS、DFS的相关性通过风险比(hazard ratio,HR)表达。文献质量评估采用纽卡斯尔-渥太华量表(Newcastle-Ottawa scale,NOS)文献质量评分;异质性检验采用Q检验和I^(2)统计量,并通过亚组分析、敏感性分析以及Meta回归分析用来探讨异质性来源。发表偏倚评价采用剪补漏斗图。软件采用R语言4.0.0版本meta包。结果:共纳入5篇文献,3907例患者。Meta分析结果显示,早期SCLC患者术后接受辅助化疗联合术后胸内照射同单纯辅助化疗相比,在OS上差异无统计学意义(HR=0.99,95%CI:0.88~1.11);但亚组分析中术后淋巴结阳性的患者OS可能获益,N_(1)患者为(HR=0.73,95%CI:0.59~0.91),N_(2)患者为(HR=0.60,95%CI:0.49~0.74)。此外,DFS存在获益(HR=0.277,95%CI:0.160~0.480)。结论:术后胸内照射治疗不能改善早期SCLC患者的OS,但亚组分析中可以延长术后淋巴结阳性患者的OS;而且无论术后淋巴结状态,胸内照射都可以延长DFS。

Objective:In this study,the prognostic value of postoperative adjuvant chemtherapy combined with intrathoracic irradiation for early SCLC was explored through a Meta-analysis.Methods:We searched the Pubmed,Embase,Cochrane Library,Web of Science,Chinese biomedical literature database,Wanfang database and CNKI database by using the retrieval method combining key words and subject headings published from the establishment to August 20th 2020 for comparing the efficacy of adjuvant chemotherapy with postoperative thoracic radiotherapy and adjuvant chemotherapy only in the treatment of SCLC with surgery.The primary endpoint was overall survival(OS)and the secondary endpoint was disease-free survival(DFS).Correlation between whether receiving postoperative thoracic radiotherapy with OS or DFS was expressed as a hazard ratio(HR).the Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of included studies.The heterogeneity was tested by Q test and I^(2)statistics,and we analyzed the sources of heterogeneity by subgroup analysis,sensitivity analysis and Meta regression analysis.The evaluation of publication bias was performed by trimmed funnel plot.The statistical software is R version 4.0.0 with meta package.Results:A total of 5 studies were involved and 3907 patients were included.The results of this Meta-analysis showed that there was no statistical difference in OS(HR=0.99,95%CI:0.88~1.11)when comparing adjuvant chemotherapy plus postoperative thoracic radiotherapy with adjuvant chemotherapy only for early SCLC patients receiving the treatment of surgery whereas the patients whose lymph nodes were positive maybe benefit from postoperative thoracic radiotherapy in subgroup analysis,like N_(1)(HR=0.73,95%CI:0.59~0.91)and N_(2)(HR=0.60,95%CI:0.49~0.74).Moreover,there was benefit in DFS(HR=0.277,95%CI:0.160~0.480).Conclusion:Postoperative thoracic radiotherapy could not improve OS for early SCLC patients but can prolong OS in some patients with positive lymph node,and can improve the outcome of DFS regardless of the lymph node status.