Division of Preventive, Occupational, and Aerospace Medicine (A.M.A.D., M.H.M.), Mayo Clinic, Rochester Minnesota 55905, Knowledge and Evaluation Research Unit (A.M.A.D., K.M., N.A., W.H.F., Z.W., M.H.F., M.H.M.), Center for the Science of Health Care Delivery, Mayo Clinic, Rochester Minnesota 55905, Library Public Services (L.J.P.), Mayo Clinic, Rochester Minnesota 55905, and Department of Medicine, Division of Endocrinology and Metabolism and Department of Neurosurgery (L.K.), Stanford University School of Medicine, Stanford, California 94305.
J Clin Endocrinol Metab. 2014 Nov;99(11):4003-14. doi: 10.1210/jc.2014-2900. Epub 2014 Oct 30.
Acromegaly is usually treated with surgery as a first-line treatment, although medical therapy has also been used as an alternative primary treatment.
We conducted a systematic review and meta-analysis to synthesize the existing evidence comparing these two approaches in treatment-naïve patients with acromegaly.
This study performed a comprehensive search in multiple databases, including Medline, EMBASE, and Scopus from early inception through April 2014.
The study used original controlled and uncontrolled studies that enrolled patients with acromegaly to receive either surgical treatment or medical treatment as their first-line treatment.
Reviewers extracted data independently and in duplicates. Because of the noncomparative nature of the available studies, we modified the Newcastle-Ottawa Scale to assess the quality of included studies. Outcomes evaluated were biochemical remission and change in IGF-1 or GH levels. We pooled outcomes using the random-effects model.
The final search yielded 35 studies enrolling 2629 patients. Studies were noncomparative series with a follow-up range of 6-360 months. Compared with medical therapy, surgery was associated with a higher remission rate (67% vs 45%; P = .02). Surgery had higher remission rates at longer follow-up periods (≥ 24 mo) (66% vs 44%; P = .04) but not the shorter follow-up periods (≤ 6 mo) (37% vs 26%; P = .22) [Corrected].Surgery had higher remission rates in the follow-up levels of GH (65% vs 46%; P = .05). In one study, the IGF-1 level was reduced more with surgery compared with medical treatment (-731 μg/L vs -251 μg/L; P = .04). Studies in which surgery was performed by a single operator reported a higher remission rate than those with multiple operators (71% vs 47%; P = .002).
Surgery may be associated with higher remission rate; however, the confidence in such evidence is very low due to the noncomparative nature of the studies, high heterogeneity, and imprecision.
肢端肥大症通常采用手术作为一线治疗方法，尽管也可以选择药物治疗作为初始主要治疗方法。
我们进行了一项系统综述和荟萃分析，以综合比较初治肢端肥大症患者这两种治疗方法的现有证据。
本研究在多个数据库（包括 Medline、EMBASE 和 Scopus）中进行了全面检索，检索时间从早期开始至 2014 年 4 月。
该研究纳入了接受手术或药物治疗作为一线治疗的肢端肥大症患者的原始对照和非对照研究。
两位审查员独立且重复提取数据。由于现有研究的非对照性质，我们修改了纽卡斯尔-渥太华量表来评估纳入研究的质量。评估的结局包括生化缓解和 IGF-1 或 GH 水平的变化。我们采用随机效应模型对结局进行合并。
最终检索得到 35 项研究，共纳入 2629 例患者。这些研究均为非对照系列研究，随访时间为 6-360 个月。与药物治疗相比，手术的缓解率更高（67%比 45%；P =.02）。手术在较长的随访时间（≥24 个月）（66%比 44%；P =.04）时具有更高的缓解率，但在较短的随访时间（≤6 个月）（37%比 26%；P =.22）[纠偏]时没有更高的缓解率。在随访的 GH 水平中，手术的缓解率更高（65%比 46%；P =.05）。在一项研究中，与药物治疗相比，手术使 IGF-1 水平降低更多（-731μg/L 比-251μg/L；P =.04）。由单一操作者进行手术的研究报告的缓解率高于由多位操作者进行手术的研究（71%比 47%；P =.002）。
手术可能与更高的缓解率相关；然而，由于研究的非对照性质、高度异质性和不精确性，这种证据的可信度非常低。
