Buderi Silviu I, Shackcloth Michael, Woolley Steven
Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
Interact Cardiovasc Thorac Surg. 2016 Nov;23(5):821-825. doi: 10.1093/icvts/ivw216. Epub 2016 Jun 29.
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether induction (neoadjuvant) chemoradiotherapy (iCRT) compared with other therapeutic strategies improves survival in patients with Pancoast tumours. Altogether 248 papers were identified using the below-mentioned search. Ten of them represented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group, relevant outcomes and weaknesses were tabulated. Four studies were retrospective comparative studies of induction chemoradiotherapy and surgery (trimodal therapy) versus other therapeutic strategies. Two studies were retrospective and four were prospective investigating trimodal therapy. These papers comprised a total of 550 patients. The overall survival was better with trimodal therapy compared with RT (radiotherapy) followed by surgery group in all three comparative studies. The 2-year survival varied in the trimodal therapy group from 70 to 93%, in comparison to RT group where variation was from 22 to 49%. Five-year survival for trimodal therapy varied between 36.4 and 84% in the results of two comparative studies, compared with 11 and 49% for RT and surgery, respectively. One paper looked at survival in patients who underwent surgery alone [30% at 2-year and 20% at 4-year overall survival (OS)]. The 5-year OS in the retrospective group varied between 38 and 59%. Similar results were reported for the prospective group with 5-year OS between 44 and 56%. Despite a large variation in pCR (complete pathological response) (15-93%) and R0 (77-100%) reported, both represented a positive prognostic factor for survival. Three papers looked at the impact of staging following induction chemoradiotherapy. The majority of patients had T3 disease. An advantage in survival was seen in patients with early disease compared with advanced stage. No randomized controlled trials were identified. All the 10 articles suggested there was a benefit in trimodal therapy with improvement in overall survival. We conclude that combining induction chemoradiotherapy with surgery for Pancoast tumour may offer a survival benefit compared with radiotherapy with surgery or surgery alone.
一篇心胸外科最佳证据主题文章是按照结构化方案撰写的。所探讨的问题是，与其他治疗策略相比，诱导（新辅助）放化疗（iCRT）是否能提高潘科斯特瘤患者的生存率。通过下述检索共识别出248篇论文。其中10篇代表了回答该临床问题的最佳证据。将作者、期刊、出版日期、国家、患者群体、相关结局及不足之处制成表格。4项研究为诱导放化疗与手术（三联疗法）对比其他治疗策略的回顾性比较研究。2项研究为回顾性研究，4项为前瞻性研究三联疗法。这些论文共纳入550例患者。在所有3项比较研究中，三联疗法组的总生存率均优于放疗后手术组。三联疗法组的2年生存率在70%至93%之间，相比之下，放疗组的生存率在22%至49%之间。两项比较研究结果显示，三联疗法的5年生存率在36.4%至84%之间，而放疗后手术组的5年生存率分别为11%和49%。一篇论文观察了单纯接受手术患者的生存率[2年总生存率（OS）为30%，4年为20%]。回顾性研究组的5年OS在38%至59%之间。前瞻性研究组的结果与之相似，5年OS在44%至56%之间。尽管报告的完全病理缓解（pCR）（15% - 93%）和R0切除（77% - 100%）差异很大，但二者均为生存的阳性预后因素。3篇论文观察了诱导放化疗后的分期影响。大多数患者为T3期疾病。与晚期患者相比，早期疾病患者的生存具有优势。未识别到随机对照试验。所有10篇文章均表明三联疗法有益，可提高总生存率。我们得出结论，与放疗后手术或单纯手术相比，潘科斯特瘤采用诱导放化疗联合手术可能具有生存获益。
