胸腺瘤切除术后辅助放疗疗效的系统评价与Meta分析

Efficacy of adjuvant radiotherapy after thymoma resection:A systematic review and meta-analysis

目的系统评价胸腺瘤切除术后放疗(postoperative radiation therapy,PORT)的疗效。方法系统检索PubMed、EMbase、The Cochrane Library、Web of Science、万方、维普、中国知网数据库,搜索建库至2024年1月公开发表的比较胸腺瘤切除术和胸腺瘤切除术+PORT治疗胸腺瘤的疗效及有效性的相关文献。采用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)对纳入的研究进行质量评价,采用Review Manager 5.4软件进行Meta分析。结果共纳入23篇文献,均为回顾性研究。共计13742例患者,其中手术组6980例,男3321例、女3659例,平均年龄54.08岁;手术+PORT组6762例,男3385例、女3377例,平均年龄53.76岁。纳入文献的NOS评分均≥7分。Meta分析结果显示,与手术组相比,手术+PORT组的1年总生存率[OR=0.32,95%CI(0.25,0.42),P<0.001]、3年总生存率[OR=0.55,95%CI(0.48,0.64),P<0.001]、5年总生存率[OR=0.66,95%CI(0.58,0.75),P<0.001]、10年总生存率[OR=0.71,95%CI(0.57,0.88),P=0.002]、1年无病生存率[OR=0.47,95%CI(0.23,0.93),P=0.030]、5年无病生存率[OR=0.61,95%CI(0.45,0.84),P=0.003]、3年疾病特异性生存率[OR=0.44,95%CI(0.35,0.55),P<0.001]、5年疾病特异性生存率[OR=0.53,95%CI(0.44,0.63),P<0.001]和10年疾病特异性生存率[OR=0.53,95%CI(0.35,0.82),P=0.004]均更高。但两组在3年无病生存率[OR=0.86,95%CI(0.61,1.22),P=0.400]、10年无病生存率[OR=0.70,95%CI(0.47,1.05),P=0.080]和1年疾病特异性生存率[OR=0.83,95%CI(0.55,1.26),P=0.380]方面差异均无统计学意义。结论胸腺瘤切除术后辅助放疗在1、3、5、10年总生存率,1、5年无病生存率,3、5、10年疾病特异性生存率方面比单纯手术治疗胸腺瘤更有优势。

Objective To systematically evaluate the efficacy of adjuvant radiotherapy after thymoma resection.Methods The PubMed,EMbase,The Cochrane Library,Web of Science,Wanfang,VIP,CNKI databases were systematically searched to find relevant literature comparing the efficacy and effectiveness of thymoma resection and thymoma resection+postoperative radiation therapy(PORT)for treating thymoma published from inception to January 2024.The Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of included retrospective studies,and Review Manager 5.4 software was used to perform meta-analysis.Results A total of 23 articles were included,all of which were retrospective studies.There were a total of 13742 patients,including 6980 patients in the simple surgery group,with 3321 males and 3659 females,and an average age of 54.08 years;6762 patients in the surgery+PORT group,with 3385 males and 3377 females,and an average age of 53.76 years.The NOS scores of the included literature were all≥7 points.The results of the meta-analysis showed that compared with the simple surgery group,the surgery+PORT group had higher 1-year overall survival rate[OR=0.32,95%CI(0.25,0.42),P<0.001],3-year overall survival rate[OR=0.55,95%CI(0.48,0.64),P<0.001],5-year overall survival rate[OR=0.66,95%CI(0.58,0.75),P<0.001],10-year overall survival rate[OR=0.71,95%CI(0.57,0.88),P=0.002],1-year disease-free survival rate[OR=0.47,95%CI(0.23,0.93),P=0.030],5-year disease-free survival rate[OR=0.61,95%CI(0.45,0.84),P=0.003],3-year disease-specific survival rate[OR=0.44,95%CI(0.35,0.55),P<0.001],5-year disease-specific survival rate[OR=0.53,95%CI(0.44,0.63),P<0.001]and 10-year disease-specific survival rate[OR=0.53,95%CI(0.35,0.82),P=0.004].But there was no statistically significant difference between the two groups in terms of 3-year disease-free survival rate[OR=0.86,95%CI(0.61,1.22),P=0.400],10-year disease-free survival rate[OR=0.70,95%CI(0.47,1.05),P=0.080]and 1-year disease-specific survival rate[OR=0.83,95%CI(0.55,1.26),P=0.380].Conclusion PORT after thymoma resection has more advantages than simple surgical treatment in terms of 1-,3-,5-,and 10-year overall survival,1-and 5-year disease-free survival,and 3-,5-and 10-year disease-specific survival.