Kwon Jeanny, Kim Byoung Hyuck, Jung Hee-Won, Besic Nikola, Sugitani Iwao, Wu Hong-Gyun
Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Division of Biological Warfare Preparedness and Response, Armed Forces Medical Research Institute, Daejeon, Republic of Korea.
Eur J Cancer. 2016 May;59:34-45. doi: 10.1016/j.ejca.2016.02.015. Epub 2016 Mar 23.
Optimal postoperative managements for anaplastic thyroid carcinoma (ATC) have not yet been sufficiently clarified. We conducted a systematic review and meta-analysis focussing on the impact of postoperative radiotherapy (PORT) in the patients with resected ATC.
Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a comprehensive search was performed in the several databases. We included the studies that reported survival outcome in the patients with or without PORT following any type of surgical resection except biopsy only. Hazard ratio (HR) was extracted, and the random-effects model was used for the pooled analysis.
Seventeen retrospective studies including 1147 analysable patients met all inclusion criteria. The overall research quality was relatively low with considerable methodological limitations. The pooled results showed that PORT significantly reduced the risk of death in all the patients with resected ATC compared with those with surgery alone (HR, 0.556; 95% confidence interval, 0.419-0.737; p < 0.001). Exploratory analyses demonstrated that patients with stage IVA (HR, 0.364; p = 0.012) and IVB (HR, 0.460; p = 0.059) may also have survival benefit from PORT, whereas stage IVC may not. No evidence of publication bias was found (p = 0.352).
This study is the first meta-analysis assessing PORT in patients with ATC and provides convincing evidence that adequate resection followed by PORT may offer the prolonged survival. However, without evidence based on prospective randomised trials, it is still not known which subset of patients can really benefit from PORT.
间变性甲状腺癌（ATC）术后的最佳管理方式尚未得到充分阐明。我们进行了一项系统评价和荟萃分析，重点关注术后放疗（PORT）对接受手术切除的ATC患者的影响。
按照系统评价和荟萃分析的首选报告项目指南，在多个数据库中进行了全面检索。我们纳入了报告了除仅活检外任何类型手术切除后接受或未接受PORT的患者生存结果的研究。提取风险比（HR），并使用随机效应模型进行汇总分析。
17项回顾性研究共纳入1147例可分析患者，均符合所有纳入标准。总体研究质量相对较低，存在相当多的方法学局限性。汇总结果显示，与单纯手术患者相比，PORT显著降低了所有接受手术切除的ATC患者的死亡风险（HR，0.556；95%置信区间，0.419 - 0.737；p < 0.001）。探索性分析表明，IVA期（HR，0.364；p = 0.012）和IVB期（HR，0.460；p = 0.059）患者可能也能从PORT中获得生存益处，而IVC期患者可能无法获益。未发现发表偏倚的证据（p = 0.352）。
本研究是第一项评估ATC患者PORT的荟萃分析，提供了令人信服的证据，表明PORT联合充分切除可能延长生存期。然而，由于缺乏前瞻性随机试验的证据，仍不清楚哪些患者亚组真正能从PORT中获益。
