Miles Oliver J, Zhou Jieyun, Paleri Sarang, Fua Tsien, Ramakrishnan Anand
Department of Plastic and Reconstructive Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
Department of Plastic and Reconstructive Surgery, The Alfred Hospital Melbourne, Melbourne, Victoria, Australia.
ANZ J Surg. 2021 Jun;91(6):1104-1109. doi: 10.1111/ans.16561. Epub 2021 Jan 12.
Chest keloids are a difficult sub-group of scars to treat, likely secondary to the high wound tension in the area that promotes excessive fibroblast proliferation and collagen deposition. Excision and adjuvant radiotherapy has been demonstrated as an efficacious treatment for keloids in general, but no meta-analysis exists to support the claims for chest keloids. This study aims to identify the rate of recurrence after surgical resection and radiotherapy on patients with chest keloids.
A search was performed using Embase, MEDLINE, Pubmed and Cochrane database on 22 December 2018 for terms 'radiotherapy', 'keloid' and 'chest'. Papers included met a prospectively designed inclusion criteria assessed by multiple investigators.
Twelve studies, including 1 randomized controlled trial, were included for a total of 400 patients with a chest keloid scar managed with surgical excision and adjuvant radiotherapy. Overall pooled-estimate of recurrence rate was 22% (95% CI 12-32%). Meta-regression did not demonstrate a significant effect for method of wound closure, type of radiotherapy, radiotherapy dose (BED ) and study type.
Excision and adjuvant radiotherapy represents an effective method of treatment for chest keloids, however sufficient prospective data, including randomized controlled trials, did not yet exist to support these findings. Further studies with sufficient sub-group analysis for keloid location are required to add to the pool of literature that can be added to this meta-analysis.
胸部瘢痕疙瘩是一类难以治疗的瘢痕亚组，可能是由于该区域伤口张力高，促使成纤维细胞过度增殖和胶原蛋白沉积。一般来说，切除联合辅助放疗已被证明是治疗瘢痕疙瘩的有效方法，但尚无荟萃分析支持针对胸部瘢痕疙瘩的相关说法。本研究旨在确定胸部瘢痕疙瘩患者手术切除并放疗后的复发率。
2018年12月22日，使用Embase、MEDLINE、Pubmed和Cochrane数据库进行检索，搜索词为“放疗”“瘢痕疙瘩”和“胸部”。纳入的论文符合由多名研究人员评估的前瞻性设计的纳入标准。
共纳入12项研究，其中包括1项随机对照试验，涉及400例接受手术切除和辅助放疗的胸部瘢痕疙瘩患者。复发率的总体合并估计值为22%（95%可信区间12 - 32%）。Meta回归未显示伤口闭合方法、放疗类型、放疗剂量（生物等效剂量）和研究类型有显著影响。
切除联合辅助放疗是治疗胸部瘢痕疙瘩的有效方法，然而，尚无足够的前瞻性数据（包括随机对照试验）来支持这些发现。需要进一步开展对瘢痕疙瘩位置进行充分亚组分析的研究，以增加可纳入该荟萃分析的文献量。
