椎体成形术联合放疗与单纯放疗治疗脊柱转移瘤的meta分析

Effects of percutaneous vertebroplasty combined with external beam radiation therapy versus external beam radiation therapy alone on spinal metastasis:a meta-analysis

目的通过meta分析评价外照射放疗联合椎体成形术(EBRT plus PVP)对比单纯放疗(EBRT)治疗脊柱转移瘤(spinal metastasis)的疗效差异。方法计算机检索CNKI、Wanfang Database、CBM、VIP、PubMed、Web of Science、Cochrane、Embase、Clinical Trials,搜集所有采用EBRT plus PVP与EBRT治疗脊柱转移瘤的对照研究,检索时限从建立数据库至2022年7月1日。由2名评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险。采用Review Manager 5.4.1软件进行meta分析。结果共纳入12篇文献,包括1篇随机对照、11篇队列研究,共1138例,meta分析结果显示,EBRT plus PVP组治疗后1 d、1、3、6、12个月视觉模拟量表(VAS)评分,总体疼痛缓解有效率,1月、3月脊柱骨转移不稳定评估(SINS)评分,局部进展/复发率,患椎病理性骨折发生率,3个月Karnofsky功能状态评分(KPS)改善率,ECOG体力状态改善率方面优于EBRT组(P<0.05)。在1个月karnofsky功能状态评分(KPS)改善率方面,两组比较差异无统计学意义(P>0.05)。结论分析显示EBRT Plus PVP比EBRT具有更好的镇痛效果及生活质量,术后病椎稳定性、增强局部抗肿瘤作用等。

Objective To evaluated the effect of external beam radiation therapy(EBRT)plus percutaneous vertebroplasty(PVP)versus EBRT alone on spinal metastasis by meta-analysis.Methods A systematic search of PubMed,Web of Science,Cochrane Library,Embase,Clinical Trials,CNKI,Wanfang,CBM,and VIP databases was conducted,and the retrieval period was from inception to July 1st,2022 to identify the controlled trials of EBRT plus PVP versus EBRT alone for treating patients with spinal metastasis.Two reviewers screened the literature,extracted data,and assessed the risk of bias in the included studies independently.The obtained data were analyzed using Review Manager 5.4.1 software.Results There were 12 studies(1 randomized controlled trials and 11 cohort studies)involving 1138 patients.The results of meta-analysis showed that the Visual Analog Scale(VAS)scores at 1 d,1,3,6,and 12 months after treatment,overall pain relief response rate at 1 and 3 months,spinal instability neoplastic score(SINS),local progression/recurrence rate,incidence of spondythopathic fractures,Karnofsky Performance Status(KPS)improvement rate at 3 months,and ECOG physical status improvement rate were better in the EBRT plus PVP group than in those treated with EBRT alone(P<0.05).No differences in KPS improvement rate at 1 month was observed between the EBRT plus PVP and the EBRT alone groups(P>0.05).Conclusion EBRT plus PVP has a better analgesic effect and produces better quality of life,postoperative vertebral stability,and enhanced local anti-tumor effect than EBRT.