双侧嗜铬细胞瘤行肾上腺全切除术与部分切除术的比较：系统评价和荟萃分析。
Total versus partial adrenalectomy in bilateral pheochromocytoma - a systematic review and meta-analysis.
机构信息
2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
Jagiellonian University Medical College, Doctoral School of Medical and Health Sciences, Kraków, Poland.
出版信息
Front Endocrinol (Lausanne). 2023 Mar 14;14:1127676. doi: 10.3389/fendo.2023.1127676. eCollection 2023.
BACKGROUND
In patients with bilateral pheochromocytoma, partial adrenalectomy offers the chance to preserve adrenal function and avoid the need for lifelong steroid supplementation. However, the risk of tumour recurrence raises questions about this procedure. The aim of our study was to compare partial and total adrenalectomy in bilateral pheochromocytoma through a systematic review with meta-analysis.
METHODS
A systematic search was carried out using databases (MEDLINE, EMBASE, Scopus, Web of Science, CENTRAL) and registers of clinical trials (ClinicalTrials.gov, European Trials Register, WHO International Trials Registry Platform). This meta-analysis included studies up to July 2022 without language restrictions. A random effects model meta-analysis was performed to assess the risk of tumor recurrence, steroid dependence and morbidity in these patients.
RESULTS
Twenty-five studies were included in the analysis involving 1444 patients. The relative risk (RR) of loss of adrenal hormone function during follow-up and the need for steroid therapy was 0.32 in patients after partial adrenalectomy: RR 0.32, 95% Confidence Interval (CI): 0.26-0.38, P < 0.00001, I2 = 21%. Patients undergoing partial adrenalectomy had a lower odds ratio (OR) for developing acute adrenal crisis: OR 0.3, 95% CI: 0.1-0.91, P=0.03, I2 = 0%. Partial adrenalectomy was associated with a higher risk of recurrence than total adrenalectomy: OR 3.72, 95% CI: 1.54-8.96, P=0.003, I2 = 28%.
CONCLUSION
Partial adrenalectomy for bilateral pheochromocytoma is a treatment that offers a chance of preserving adrenal hormonal function, but is associated with a higher risk of local tumor recurrence. There was no difference for the risk of metastasis and in overall mortality among the group with bilateral pheochromocytomas undergoing total or partial adrenalectomy. This study is in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) Guidelines (10, 11).
SYSTEMATIC REVIEW REGISTRATION
背景
在双侧嗜铬细胞瘤患者中，部分肾上腺切除术提供了保留肾上腺功能和避免终身类固醇替代治疗的机会。然而，肿瘤复发的风险引发了对该手术的质疑。我们的研究目的是通过系统回顾和荟萃分析比较双侧嗜铬细胞瘤的部分和全部肾上腺切除术。
方法
使用数据库（MEDLINE、EMBASE、Scopus、Web of Science、CENTRAL）和临床试验登记处（ClinicalTrials.gov、欧洲临床试验登记处、世界卫生组织国际临床试验注册平台）进行系统检索。该荟萃分析纳入了截至 2022 年 7 月的无语言限制的研究。采用随机效应模型荟萃分析评估这些患者肿瘤复发、类固醇依赖和发病率的风险。
结果
分析纳入了 25 项研究，共 1444 名患者。部分肾上腺切除术患者在随访期间失去肾上腺激素功能和需要类固醇治疗的相对风险（RR）为 0.32：RR 0.32，95%置信区间（CI）：0.26-0.38，P<0.00001，I2=21%。接受部分肾上腺切除术的患者发生急性肾上腺危象的优势比（OR）较低：OR 0.3，95%CI：0.1-0.91，P=0.03，I2=0%。与全肾上腺切除术相比，部分肾上腺切除术与更高的复发风险相关：OR 3.72，95%CI：1.54-8.96，P=0.003，I2=28%。
结论
双侧嗜铬细胞瘤的部分肾上腺切除术是一种保留肾上腺激素功能的治疗方法，但与局部肿瘤复发的风险增加相关。对于接受全或部分肾上腺切除术的双侧嗜铬细胞瘤患者，转移风险和总死亡率没有差异。这项研究符合 PRISMA（系统评价和荟萃分析的首选报告项目）和 AMSTAR（评估系统评价的测量工具）指南（10,11）。
系统评价注册
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