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辐射相关淋巴细胞减少对高级别胶质瘤预后影响的系统评价与Meta分析

A Systematic Review and Meta-analysis of the Impact of Radiation-Related Lymphopenia on Outcomes in High-Grade Gliomas.

作者信息

Mallick Supriya, V R Anjali, Giridhar Prashanth, Upadhyay Rituraj, Kim Byung-Kyu, Sharma Amrish, Elghazawy Hagar, Elumalai Thiraviyam, Solipuram Vinod, Hsieh Cheng En, Hentz Courtney, Solanki Abhishek A, Li Jing, Chan Dennis Pai, Ness Emily, Venkatesulu Bhanu Prasad, Grosshans David R

机构信息

Department of Radiation Oncology, National Cancer Institute, New Delhi, India.

Department of Radiation Oncology, AIIMS, New Delhi, India.

出版信息

South Asian J Cancer. 2022 Aug 23;11(4):361-369. doi: 10.1055/s-0042-1753504. eCollection 2022 Oct.

Abstract

Supriya Mallick  Malignant gliomas are the most common primary malignant brain tumors and are typically treated with maximal safe surgical resection followed by chemoradiation. One of the unintended effects of radiation is depletion of circulating lymphocyte pool, which has been correlated with inferior overall survival outcomes.  A comprehensive and systematic searches of the PubMed, Cochrane Central, and Embase databases were done to assess the studies that have reported radiation-related lymphopenia in high-grade gliomas. Hazard ratios (HRs), odds ratios (OR), and mean differences were represented with Forest plots comparing patients with severe lymphopenia and no severe lymphopenia. Review Manager Version 5.3 (The Nordic Cochrane Centre, Copenhagen, Denmark) was used for the analysis.  Nineteen studies were included in the final systematic review and 12 studies were included in the meta-analysis. The odds of developing severe lymphopenia were 0.39 (95% CI:0.19, 0.81,  = 94%,  = 0.01). Patients with severe lymphopenia were at increased risk of death with a pooled HR = 2.19 (95% CI: 1.70, 2.83,  = 0%, <0.00001) compared to patients with no severe lymphopenia. The mean difference in survival between patients with severe lymphopenia and no severe lymphopenia was -6.72 months (95% CI: -8.95, -4.49,  = 99%, <0.00001), with a better mean survival in the no severe lymphopenia group.  Radiation-induced severe lymphopenia was associated with poor overall survival and increased risk of death. Photon therapy, larger planning target volume, higher brain dose, higher hypothalamus dose, and female gender were associated with increased risk of severe lymphopenia.

摘要

苏普丽雅·马利克 恶性胶质瘤是最常见的原发性恶性脑肿瘤,通常采用最大安全限度的手术切除,随后进行放化疗。放疗的意外影响之一是循环淋巴细胞池减少,这与总体生存结果较差相关。

对PubMed、Cochrane Central和Embase数据库进行了全面系统的检索,以评估报告高级别胶质瘤放疗相关淋巴细胞减少的研究。通过森林图比较严重淋巴细胞减少患者和无严重淋巴细胞减少患者的风险比(HRs)、优势比(OR)和均值差异。使用Review Manager 5.3版(丹麦哥本哈根北欧Cochrane中心)进行分析。

最终的系统评价纳入了19项研究,荟萃分析纳入了12项研究。发生严重淋巴细胞减少的几率为0.39(95%CI:0.19,0.81,I² = 94%,P = 0.01)。与无严重淋巴细胞减少的患者相比,严重淋巴细胞减少的患者死亡风险增加,合并HR = 2.19(95%CI:1.70,2.83,I² = 0%,P < 0.00001)。严重淋巴细胞减少患者与无严重淋巴细胞减少患者的生存均值差异为-6.72个月(95%CI:-8.95,-4.49,I² = 99%,P < 0.00001),无严重淋巴细胞减少组的平均生存期更好。

放疗引起的严重淋巴细胞减少与总体生存不良和死亡风险增加相关。光子治疗、较大的计划靶体积、较高的脑剂量、较高的下丘脑剂量以及女性性别与严重淋巴细胞减少风险增加相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4ce8/9902102/d1cb572e4906/10-1055-s-0042-1753504-i2190622-3.jpg

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