Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Int J Radiat Oncol Biol Phys. 2016 Apr 1;94(5):1129-36. doi: 10.1016/j.ijrobp.2016.01.007. Epub 2016 Jan 14.
To evaluate the survival impact of postoperative radiation therapy (PORT) in stage II to IV thymomas, using systematic review and meta-analysis.
A database search was conducted with EMBASE, PubMed, Web of Science, Cochrane Library, and Ovid from inception to August 2015. Thymic carcinomas were excluded, and studies comparing overall survival (OS) with and without PORT in thymomas were included. The hazard ratios (HRs) of OS were extracted, and a random-effects model was used in the pooled analysis.
Seven retrospective series with a total of 1724 patients were included and analyzed. Almost all of the patients underwent macroscopically complete resection, and thymoma histology was confirmed by the World Health Organization criteria. In the overall analysis of stage II to IV thymomas, OS was not altered with the receipt of PORT (HR 0.79, 95% confidence interval [CI] 0.58-1.08). Although PORT was not associated with survival difference in Masaoka stage II disease (HR 1.45, 95% CI 0.83-2.55), improved OS was observed with the addition of PORT in the discrete pooled analysis of stage III to IV (HR 0.63, 95% CI 0.40-0.99). Significant heterogeneity and publication bias were not found in the analyses.
From the present meta-analysis of sole primary thymomas, we suggest the potential OS benefit of PORT in locally advanced tumors with macroscopically complete resection, but not in stage II disease. Further investigations with sufficient survival data are needed to establish detailed treatment indications.
通过系统评价和荟萃分析，评估术后放疗（PORT）对 II 期至 IV 期胸腺瘤的生存影响。
从 1990 年 1 月至 2015 年 8 月，我们在 EMBASE、PubMed、Web of Science、Cochrane 图书馆和 Ovid 数据库中进行了检索。排除胸腺癌，并纳入了比较 PORT 与无 PORT 治疗胸腺瘤的总生存（OS）的研究。提取 OS 的风险比（HR），并在汇总分析中使用随机效应模型。
共纳入并分析了 7 项回顾性系列研究，共 1724 例患者。几乎所有患者均接受了大体完全切除，且胸腺瘤组织学均符合世界卫生组织标准。在 II 期至 IV 期胸腺瘤的总体分析中，PORT 并未改变 OS（HR 0.79，95%置信区间 [CI] 0.58-1.08）。尽管 PORT 与 Masaoka 分期 II 期疾病的生存差异无关（HR 1.45，95%CI 0.83-2.55），但在离散的 III 期至 IV 期亚组分析中，PORT 的加入观察到 OS 改善（HR 0.63，95%CI 0.40-0.99）。分析中未发现显著的异质性和发表偏倚。
从目前对单纯原发性胸腺瘤的荟萃分析来看，我们认为 PORT 对大体完全切除的局部晚期肿瘤有潜在的 OS 获益，但对 II 期疾病没有获益。需要进一步进行有足够生存数据的研究，以建立详细的治疗指征。
