Han Qian, Liang Hengpo, Cheng Peng, Yang Hongjie, Zhao Pingfan
Department of Radiotherapy, Henan Provincial People's Hospital, Zhengzhou, China.
Department of Outpatient, Henan Provincial People's Hospital, Zhengzhou, China.
Front Oncol. 2020 Mar 18;10:151. doi: 10.3389/fonc.2020.00151. eCollection 2020.
The optimal strategy for the management of high-grade glioma in the elderly (≥60.0 years) remains controversial, especially regarding the effects of surgical extent on survival outcomes. The purpose of this study was to compare gross total resection (GTR) with subtotal resection (STR) for treatment effects in elderly patients with high-grade glioma. Three electronic databases were systematically searched, including PubMed, EmBase, and the Cochrane library, from inception to August 2018. Hazard ratios (HRs) or odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were used to express summary effect estimates using the random-effects model. Nineteen retrospective observational studies involving a total of 10,815 elderly patients with high-grade glioma were included in this meta-analysis. The summary results indicated that GTR was associated with a significant improvement in overall survival (OS) compared with STR (HR = 0.70, 95% CI = 0.64-0.77). In addition, elderly patients administered GTR showed lower risk of 3-month mortality (OR = 0.47, 95% CI = 0.24-0.93), 6-month mortality (OR = 0.38, 95% CI = 0.26-0.56), 9-month mortality (OR = 0.35, 95% CI = 0.25-0.49), and 1-year mortality (OR = 0.40, 95% CI = 0.29-0.56). Pooled OS data differed when stratified by publication year, country, sample size, disease status, and study quality. GTR seems to be more effective than STR in achieving longer survival in elderly patients with high-grade glioma.
老年（≥60.0岁）高级别胶质瘤的最佳治疗策略仍存在争议，尤其是手术范围对生存结果的影响。本研究的目的是比较老年高级别胶质瘤患者接受全切除（GTR）与次全切除（STR）的治疗效果。系统检索了三个电子数据库，包括PubMed、EmBase和Cochrane图书馆，检索时间从创建至2018年8月。使用随机效应模型，用风险比（HRs）或比值比（ORs）及相应的95%置信区间（CIs）来表示汇总效应估计值。本荟萃分析纳入了19项回顾性观察性研究，共涉及10815例老年高级别胶质瘤患者。汇总结果表明，与STR相比，GTR与总生存期（OS）显著改善相关（HR = 0.70，95%CI = 0.64 - 0.77）。此外，接受GTR的老年患者3个月死亡率（OR = 0.47，95%CI = 0.24 - 0.93）、6个月死亡率（OR = 0.38，95%CI = 0.26 - 0.56）、9个月死亡率（OR = 0.35，95%CI = 0.25 - 0.49）和1年死亡率（OR = 0.40，95%CI = 0.29 - 0.56）的风险更低。按发表年份、国家、样本量、疾病状态和研究质量分层时，汇总的OS数据有所不同。在实现老年高级别胶质瘤患者更长生存期方面，GTR似乎比STR更有效。
