Holscher Isabelle, van den Berg Tijs J, Dreijerink Koen M A, Engelsman Anton F, Nieveen van Dijkum Els J M
Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, AZ, The Netherlands.
Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Amsterdam, AZ, The Netherlands.
J Clin Endocrinol Metab. 2021 Jan 23;106(2):588-597. doi: 10.1210/clinem/dgaa794.
Evidence on follow-up duration for patients with sporadic pheochromocytomas is absent, and current guidelines of the European Society of Endocrinology, American Association of Clinical Endocrinologists and Endocrine Surgeons, and the Endocrine Society are ambiguous about the appropriate duration of follow-up. The aim of this systematic review and meta-analysis is to evaluate the recurrence rate of sporadic pheochromocytomas after curative adrenalectomy.
A literature search in PubMed, Embase, and the Cochrane Library was performed. A study was eligible if it included a clear report on the number of sporadic patients, recurrence rate, and follow-up duration. Studies with an inclusion period before 1990, <2 years of follow-up, <10 patients, and unclear data on the sporadic nature of pheochromocytomas were excluded. A meta-analysis on recurrence was performed provided that the heterogeneity was low (I2 < 25%) or intermediate (I2 26-75%). Hozo's method was used to calculate weighted mean follow-up duration and weighted time to recurrence with combined standard deviations (SDs).
A total of 13 studies, including 430 patients, were included in the synthesis. The meta-analysis results describe a pooled recurrence rate after curative surgery of 3% (95% confidence interval: 2-6%, I2 = 0%), with a weighted mean time to recurrence of 49.4 months (SD = 30.7) and a weighted mean follow-up period of 77.3 months (SD = 32.2).
This meta-analysis shows a very low recurrence rate of 3%. Prospective studies, including economical and health effects of limited follow-up strategies for patients with truly sporadic pheochromocytomas should be considered.
散发性嗜铬细胞瘤患者的随访持续时间尚无相关证据，欧洲内分泌学会、美国临床内分泌医师协会与内分泌外科医师协会以及内分泌学会的现行指南对于合适的随访持续时间也未明确说明。本系统评价与荟萃分析的目的是评估根治性肾上腺切除术后散发性嗜铬细胞瘤的复发率。
在PubMed、Embase和Cochrane图书馆进行文献检索。若研究明确报告了散发性患者数量、复发率和随访持续时间，则该研究符合纳入标准。排除纳入期在1990年之前、随访时间<2年、患者数量<10例以及嗜铬细胞瘤散发性数据不明确的研究。若异质性较低（I2<25%）或中等（I2 26 - 75%），则对复发情况进行荟萃分析。采用Hozo法计算加权平均随访持续时间以及复发加权时间，并合并标准差（SD）。
共纳入13项研究，包括430例患者。荟萃分析结果显示，根治性手术后的汇总复发率为3%（95%置信区间：2 - 6%，I2 = 0%），复发加权平均时间为49.4个月（SD = 30.7），加权平均随访期为77.3个月（SD = 32.2）。
本荟萃分析显示复发率极低，为3%。应考虑开展前瞻性研究，包括对真正散发性嗜铬细胞瘤患者采用有限随访策略的经济和健康影响。
