Department of Rehabilitation Medicine, Nara Medical University, Nara, Japan.
Department of Orthopedic Surgery, Nippon Medical School, Tokyo, Japan.
Jpn J Clin Oncol. 2022 Feb 5;52(2):151-156. doi: 10.1093/jjco/hyab185.
This systematic review assessed and compared the efficacy of marginal resection to wide resection in patients with atypical lipomatous tumours (ALT) by evaluating the local recurrence rates, overall survival and adverse event rates.
We evaluated studies published between 1 January 1990 and 31 January 2019. The risks of bias in the selected studies were analyzed using the Cochrane Collaboration Risk of Bias Tool. The quality of the evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation approach.
Three case-control studies and three case series studies were identified. A meta-analysis was performed of six studies to evaluate the local recurrence rate after resection. Comparison of marginal and wide resections showed that the local recurrence rate was not significantly higher in the marginal resection group (14.2 and 1.4%, odds ratio: 2.88, 95% confidence interval 0.99-8.33, P = 0.05). We observed no difference in overall survival. In one study, the rates of adverse events were 14.7% in the marginal resection group and 45.4% in the wide treatment group (odds ratio, 0.32; 95% confidence interval 0.11-80.91, P < 0.05).
In our analyses, five of six studies reported no recurrence for wide resection, compared to three to seven recurrences in the marginal resection group. One study reported only one case of recurrence for wide resection. Because ALT has a relatively good prognosis, the use of marginal resection is acceptable to preserve musculoskeletal function.
本系统评价通过评估局部复发率、总生存率和不良事件发生率，评估了边缘切除术与广泛切除术治疗非典型性脂肪肿瘤（ALT）患者的疗效。
我们评估了 1990 年 1 月 1 日至 2019 年 1 月 31 日期间发表的研究。使用 Cochrane 协作风险偏倚工具分析选定研究的偏倚风险。使用推荐评估、制定与评价（GRADE）方法评估证据质量。
确定了 3 项病例对照研究和 3 项病例系列研究。对 6 项研究进行了荟萃分析，以评估切除术后的局部复发率。边缘切除术与广泛切除术的比较显示，边缘切除术组的局部复发率并不显著更高（14.2%和 1.4%，优势比：2.88，95%置信区间 0.99-8.33，P=0.05）。我们观察到总生存率没有差异。在一项研究中，边缘切除术组的不良事件发生率为 14.7%，广泛治疗组为 45.4%（比值比，0.32；95%置信区间 0.11-80.91，P<0.05）。
在我们的分析中，6 项研究中有 5 项报告广泛切除术无复发，而边缘切除术组有 3 至 7 例复发。一项研究仅报告了一例广泛切除术复发。由于 ALT 的预后相对较好，保留肌肉骨骼功能时可以接受边缘切除术。
