对比分析胶质瘤患者行全切除与近全切除的疗效：一项荟萃分析。
Comparative assessment of the efficacy of gross total versus subtotal total resection in patients with glioma: A meta-analysis.
机构信息
2nd Department of Neurology Central, Suining Central Hospital, Suining, 629000, China.
1st Department of Neurology Central, Suining Central Hospital, Suining, 629000, China.
出版信息
Int J Surg. 2019 Mar;63:90-97. doi: 10.1016/j.ijsu.2019.02.004. Epub 2019 Feb 8.
BACKGROUND
It is controversial whether to plan for a subtotal or gross total resection (GTR) of lesions in patients with gliomas. Several studies have demonstrated that GTR may be superior to subtotal resection (STR) with regard to improving the survival rates of patients with glioma. Thus, the present meta-analysis was designed to compare and evaluate the efficacy of GTR for improving clinical outcomes of patients with glioma.
METHODS
We searched the Cochrane Library, PubMed, Embase, and Web of Science for the interval between March 1972 to November 2018 to identify relevant original studies that compared the efficacy of GTR and STR in patients with gliomas. Mean differences (MDs) with 95% confidence intervals (CIs) were estimated to compare the outcomes of the GTR and STR groups. We also performed subgroup and sensitivity analyses to further explore the effects of the extent of surgical resection (EOR) and assess the stability of the combined results. Two external (blinded) reviewers assessed the quality of the trials and the extracted data independently. All statistical analyses were performed using standard statistical procedures provided in Review Manager 5.2.
RESULTS
We included 42 studies (N = 5920 participants) in this meta-analysis. Significantly superior efficacy was detected for GTR to improve overall survival compared to STR (MD 4.01, 95% CI 2.52-5.51; P < 0.00001), 5-year survival rate (OR 4.08, 95% CI 3.02-5.52; P < 0.00001), progression-free survival (MD 2.08, 95% CI 0.26-3.89; P = 0.02), seizure control (OR 4.25, 95% CI 2.99-6.05; P < 0.00001), and reducing the incidence of malignant transformation (OR 0.28; 95% CI 0.13-0.60; P = 0.001) in patients with glioma.
CONCLUSIONS
Our meta-analysis supports the superior efficacy of GTR on survival, functional outcome, tumor progression, seizure control, malignant transformation, morbidity, and mortality in patients with glioma.
背景
对于胶质瘤患者，是行次全切除还是全切（GTR）一直存在争议。几项研究表明，GTR 可能优于次全切除（STR），可以提高胶质瘤患者的生存率。因此，本 meta 分析旨在比较和评估 GTR 改善胶质瘤患者临床结局的疗效。
方法
我们检索了 Cochrane 图书馆、PubMed、Embase 和 Web of Science，时间跨度为 1972 年 3 月至 2018 年 11 月，以确定比较 GTR 和 STR 治疗胶质瘤患者疗效的相关原始研究。使用均数差值（MD）和 95%置信区间（CI）来比较 GTR 和 STR 组的结局。我们还进行了亚组和敏感性分析，以进一步探讨手术切除范围（EOR）的影响，并评估合并结果的稳定性。两位外部（盲法）审查员独立评估试验质量和提取数据。所有统计分析均使用 Review Manager 5.2 中提供的标准统计程序进行。
结果
我们纳入了 42 项研究（N=5920 名参与者）进行 meta 分析。与 STR 相比，GTR 显著提高了总生存率（MD 4.01，95%CI 2.52-5.51；P<0.00001）、5 年生存率（OR 4.08，95%CI 3.02-5.52；P<0.00001）、无进展生存率（MD 2.08，95%CI 0.26-3.89；P=0.02）、癫痫控制率（OR 4.25，95%CI 2.99-6.05；P<0.00001）和降低恶性转化发生率（OR 0.28；95%CI 0.13-0.60；P=0.001）。
结论
本 meta 分析支持 GTR 改善胶质瘤患者生存、功能结局、肿瘤进展、癫痫控制、恶性转化、发病率和死亡率的疗效。
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