Zhu Meikai, Liu Zhifeng, Zhou Yongheng, Jiang Zhiwen, Chen Shouzhen, Wang Wenfu, Shi Benkang, Zhu Yaofeng
Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.
Department of Urology, Tai'an City Central Hospital, Tai'an, Shandong 271000, P.R. China.
Oncol Lett. 2024 Feb 19;27(4):162. doi: 10.3892/ol.2024.14295. eCollection 2024 Apr.
To evaluate the effects of neoadjuvant vascular endothelial growth factor-tyrosine kinase inhibitor (VEGF-TKI) treatment on surgery in patients with renal cell carcinoma (RCC), sources from Embase, PubMed and the Cochrane Library databases collected from inception to December, 2022 were used for analysis in the present study, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data regarding surgical outcomes were collected. The pooled effect sizes were calculated in terms of the risk ratio (RR)/standard mean difference (SMD) with 95% confidence intervals (CIs) using the random-effects model. Subgroup and sensitivity analyses were used to explore the source of heterogeneity within the data. In total, 9 identified articles involving 829 patients (336 in the neoadjuvant + surgery group; 493 in the surgery group) were included in the present study, according to the criteria. The results demonstrated that there were no significant differences in blood loss (SMD=-0.11; 95% CI, -0.63-0.41; P=0.68), postoperative length of hospital stay or total length of hospital stay (SMD=0.23; 95% CI, -0.55-1.01; P=0.57) or complications (RR=1.16; 95% CI, 0.80-1.67; P=0.44) between the two groups. However, neoadjuvant therapy reduced the operation time (SMD=-0.67; 95% CI, -1.25- -0.09; P=0.02) and resulted in a greater proportion of patients choosing partial nephrectomy (RR=1.84; 95% CI, 1.47-2.31; P<0.00001). In the subgroup analysis, the blood loss was significantly lower in patients with RCC with inferior vena cava tumor thrombus in the neoadjuvant group (SMD=-1.10; 95% CI, -1.82- -0.38; P=0.003). In conclusion, the results of the present study indicated that neoadjuvant VEGF-TKI treatment in patients with RCC shortened operation time, decreased blood loss and did not cause an increase in perioperative complications. In addition, this treatment modality may encourage patients to opt for partial nephrectomy to preserve renal function.
为评估新辅助血管内皮生长因子 - 酪氨酸激酶抑制剂（VEGF - TKI）治疗对肾细胞癌（RCC）患者手术的影响，根据系统评价和Meta分析的首选报告项目指南，本研究使用了从创刊至2022年12月从Embase、PubMed和Cochrane图书馆数据库收集的资料进行分析。收集了有关手术结果的数据。采用随机效应模型计算合并效应量，以风险比（RR）/标准化均数差（SMD）及其95%置信区间（CI）表示。采用亚组分析和敏感性分析探索数据异质性来源。根据纳入标准，本研究共纳入9篇已识别的文章，涉及829例患者（新辅助治疗 + 手术组336例；手术组493例）。结果表明，两组在失血量（SMD = -0.11；95%CI，-0.63 - 0.41；P = 0.68）、术后住院时间或总住院时间（SMD = 0.23；95%CI，-0.55 - 1.01；P = 0.57）或并发症（RR = 1.16；95%CI，0.80 - 1.67；P = 0.44）方面无显著差异。然而，新辅助治疗缩短了手术时间（SMD = -0.67；95%CI，-1.25 - -0.09；P = 0.02），并使更多患者选择部分肾切除术（RR = 1.84；95%CI，1.47 - 2.31；P < 0.00001）。在亚组分析中，新辅助治疗组下腔静脉肿瘤血栓的RCC患者失血量显著更低（SMD = -1.10；95%CI，-1.82 - -0.38；P = 0.003）。总之，本研究结果表明，RCC患者新辅助VEGF - TKI治疗可缩短手术时间、减少失血量且不会导致围手术期并发症增加。此外，这种治疗方式可能鼓励患者选择部分肾切除术以保留肾功能。
