Hamaji Masatsugu, Kojima Fumitsugu, Omasa Mitsugu, Sozu Takashi, Sato Tosiya, Chen Fengshi, Sonobe Makoto, Date Hiroshi
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Eur J Cardiothorac Surg. 2015 Apr;47(4):602-7. doi: 10.1093/ejcts/ezu277. Epub 2014 Jul 11.
Observational studies on long-term outcomes following debulking surgery or surgical biopsy for unresectable thymoma showed various results. This meta-analysis was designed to determine the effect of debulking surgery against surgical biopsy on overall survival in patients with unresectable thymoma. The PubMed database was queried for studies published in the English language on unresectable thymoma and overall survival. We compared overall survival following surgery in patients undergoing debulking surgery and patients undergoing surgical biopsy for unresectable thymoma. Meta-analysis was performed using the Mantel-Haenszel method, and potential publication bias was evaluated with a funnel plot of precision. No randomized trials on this topic were identified. Thirteen retrospective observational studies containing a sum of 314 patients with information on the number of deaths and person-years were suitable for analysis. Information on Masaoka stages, World Health Organization histology and indications for debulking surgery versus surgical biopsy was lacking in most studies. Diversity of neoadjuvant and adjuvant treatments was noted among the eligible studies. One hundred and seventy-two (54.8%) patients underwent debulking surgery and 142 (45.2%) underwent surgical biopsy. The pooled hazard ratio was 0.451 (95% confidence interval: 0.336-0.605, P < 0.001), favouring patients undergoing debulking surgery compared with patients undergoing surgical biopsy. The funnel plot of precision demonstrated no important publication bias. Our results suggest that debulking surgery for unresectable thymoma may be associated with improved overall survival and be considered for patients with unresectable thymoma.
关于不可切除胸腺瘤行减瘤手术或手术活检后的长期预后的观察性研究结果各异。本荟萃分析旨在确定减瘤手术与手术活检相比对不可切除胸腺瘤患者总生存期的影响。在PubMed数据库中检索以英文发表的关于不可切除胸腺瘤和总生存期的研究。我们比较了不可切除胸腺瘤行减瘤手术患者和行手术活检患者术后的总生存期。采用Mantel-Haenszel方法进行荟萃分析，并用精度漏斗图评估潜在的发表偏倚。未发现关于该主题的随机试验。13项回顾性观察性研究共纳入314例患者，这些患者有死亡人数和人年数的信息，适合进行分析。大多数研究缺乏关于Masaoka分期、世界卫生组织组织学以及减瘤手术与手术活检指征的信息。在符合条件的研究中，新辅助和辅助治疗存在多样性。172例（54.8%）患者接受了减瘤手术，142例（45.2%）接受了手术活检。合并风险比为0.451（95%置信区间：0.336 - 0.605，P < 0.001），与接受手术活检的患者相比，接受减瘤手术的患者更具优势。精度漏斗图显示无重要的发表偏倚。我们的结果表明，不可切除胸腺瘤的减瘤手术可能与总生存期改善相关，对于不可切除胸腺瘤患者可考虑采用。
