Nakasu Satoshi, Nakasu Yoko, Tsuji Atsushi, Fukami Tadateru, Nitta Naoki, Kawano Hiroto, Notsu Akifumi, Nozaki Kazuhiko
Division of Neurosurgery, Omi Medical Center, Kusatsu, Japan.
Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Japan.
Neurooncol Pract. 2022 Sep 18;10(2):113-125. doi: 10.1093/nop/npac073. eCollection 2023 Apr.
Better overall survival (OS) reported in patients with incidental diffuse low-grade glioma (iLGG) in comparison to symptomatic LGG (sLGG) may be overestimated by lead-time and length-time.
We performed a systematic review and meta-analysis of studies on adult hemispheric iLGGs according to the PRISMA statement to adjust for biases in their outcomes. Survival data were extracted from Kaplan-Meier curves. Lead-time was estimated by 2 methods: Pooled data of time to become symptomatic (LTs) and time calculated from the tumor growth model (LTg).
We selected articles from PubMed, Ovid Medline, and Scopus since 2000. Five compared OS between patients with iLGG ( = 287) and sLGG ( = 3117). The pooled hazard ratio (pHR) for OS of iLGG to sLGG was 0.40 (95% confidence interval [CI] {0.27-0.61}). The estimated mean LTs and LTg were 3.76 years ( = 50) and 4.16-6.12 years, respectively. The corrected pHRs were 0.64 (95% CI [0.51-0.81]) by LTs and 0.70 (95% CI [0.56-0.88]) by LTg. In patients with total removal, the advantage of OS in iLGG was lost after the correction of lead-time. Patients with iLGG were more likely to be female pooled odds ratio (pOR) 1.60 (95% CI [1.25-2.04]) and have oligodendrogliomas (pOR 1.59 [95% CI {1.05-2.39}]). Correction of the length-time bias, which increased the pHR by 0.01 to 0.03, preserved the statistically significant difference in OS.
The reported outcome in iLGG was biased by lead-time and length-time. Although iLGG had a longer OS after correction of biases, the difference was less than previously reported.
与症状性低级别胶质瘤（sLGG）相比，偶发性弥漫性低级别胶质瘤（iLGG）患者报告的总生存期（OS）更长，这可能因领先时间和病程时间而被高估。
我们根据PRISMA声明对成人半球性iLGG的研究进行了系统评价和荟萃分析，以校正其结果中的偏倚。生存数据从Kaplan-Meier曲线中提取。领先时间通过两种方法估计：出现症状的时间汇总数据（LTs）和根据肿瘤生长模型计算的时间（LTg）。
我们检索了自2000年以来PubMed、Ovid Medline和Scopus上的文章。5项研究比较了iLGG患者（n = 287）和sLGG患者（n = 3117）的OS。iLGG与sLGG的OS合并风险比（pHR）为0.40（95%置信区间[CI] {0.27 - 0.61}）。估计的平均LTs和LTg分别为3.76年（n = 50）和4.16 - 6.12年。校正后的pHR通过LTs为0.64（95% CI [0.51 - 0.81]），通过LTg为0.70（95% CI [0.56 - 0.88]）。在全切患者中，校正领先时间后，iLGG在OS方面的优势消失。iLGG患者更可能为女性，合并优势比（pOR）为1.60（95% CI [1.25 - 2.04]），且更易患少突胶质细胞瘤（pOR 1.59 [95% CI {1.05 - 2.39}]）。校正病程时间偏倚（使pHR增加0.01至0.03）后，OS的统计学显著差异仍然存在。
iLGG报告的结果存在领先时间和病程时间偏倚。尽管校正偏倚后iLGG的OS更长，但差异小于先前报告。
