胸部肿瘤放射性心脏损伤的系统评价和Meta分析

Systematic evaluation and Meta-analysis of radiation-induced heart injury in thoracic tumor

目的系统评价胸部肿瘤放疗后心脏毒性的发生率,为临床工作中放射性心脏损伤(RIHD)的评估和预防提供循证医学依据。方法检索PubMed、Web of Science、Embase、Cochrane图书馆、中国知网、万方数据库,检索起止时间为2007年1月至2018年1月,并查询所有纳入文献的参考文献。两名研究者根据纳入与排除标准筛选文献,采用美国医疗保健研究与质量机构(AHRQ)量表评估文献质量,使用Stata 12.0软件进行Meta分析。结果 24篇文献纳入Meta分析,共1 870例胸部肿瘤患者,RIHD的总发生率为42%(95%CI:0.32～0.52);其中心电图异常率为37%,心肌酶异常率为20%,肌钙蛋白异常率为12%。不同肿瘤类型分层研究,RIHD发生率不同:乳腺癌患者为15%,食管癌为29%,肺癌为39%。不同评价标准分层分析:以放射治疗肿瘤组(RTOG)标准评价,RIHD发生率为15%;而以美国国立癌症研究所常见毒性事件标准(NCI-CTCAE)评价,RIHD发生率为59%。结论胸部肿瘤患者RIHD总发生率高达42%,临床观察指标中以心电图异常最为常见;不同部位肿瘤RIHD发生率有较大差异,肺癌RIHD发生率最高,食管癌次之,乳腺癌最低;以CTCAE标准评价,RIHD发生率明显高于RTOG标准。

Objective To systematically evaluate the incidence of cardiotoxicity after radiotherapy for thoracic tumors,and to provide evidence-based medical basis for the evaluation and prevention of radiation-induced heart injury(RIHD)in clinical work.Methods Search PubMed,Web of Science,Embase,Cochrane Library,CNKI and Wanfang database.Search time ranged from January 2007 to January 2018.And all references included in the literatures were searched.Two researchers screened literatures according to inclusion and exclusion criteria.The quality of literatures was assessed by Agency for Healthcare Research and Quality(AHRQ),and Meta-analysis was performed by Stata 12.0 software.Results Twenty-four articles of 1 870 patients with thoracic tumor were included in the Meta-analysis.The total incidence of RIHD was 42%(95%CI:0.32-0.52),among which the abnormal rate of ECG was 37%,the abnormal rate of myocardial enzymes was 20%,and the abnormal rate of troponin was 12%.In stratified study of different types of tumors showed the incidence of RIHD was different:15%of breast cancer,29%of esophageal cancer and 39%of lung cancer.Hierarchical analysis of different evaluation criteria:the incidence of RIHD was 15%according to Radiation Therapy Oncology Group(RTOG)criteria,and 59%according to National Cancer Institute-Common Terminology Criteria for Adverse Events(NCI-CTCAE)criteria.Conclusions The total incidence of RIHD in patients with thoracic tumors is as high as 42%,and the abnormal electrocardiogram is the most common clinical observation index.The incidence of RIHD in different parts of tumors is quite different with the highest in lung cancer,followed by esophageal cancer and the lowest in breast cancer.According to CTCAE standard,the incidence of RIHD is significantly higher than that of RTOG standard.