WHO 2级脑膜瘤单纯手术与手术加辅助放疗的比较：事件发生时间数据重建的Meta分析

Surgery alone versus surgery plus adjuvant radiotherapy for WHO grade 2 meningioma: meta-analysis of reconstructed time-to-event data.

作者信息

Verly Gabriel, Bresciani Lucas, Delfino Thiffany, Nascimento Marcos, Magill Stephen T, Galvão Gustavo da Fontoura

机构信息

Department of Neurosurgery, Federal University of Rio de Janeiro, University Hospital Clementino Fraga Filho, Rio de Janeiro, RJ, Brazil.

Feinberg School of Medicine, Department of Neurological Surgery, Northwestern University, 633 Clark Street. ZIP 60208, Evanston, IL, USA.

出版信息

Neurosurg Rev. 2024 Sep 28;47(1):702. doi: 10.1007/s10143-024-02946-4.

DOI:10.1007/s10143-024-02946-4

PMID:39333271

Abstract

INTRODUCTION

WHO Grade 2 meningiomas present diagnostic and management challenges. Surgery, particularly gross total resection (GTR), is crucial, often followed by adjuvant radiotherapy (RT); however, there are clinical equipoise and ongoing randomized trials of RT after GTR.

METHODS

This systematic review evaluates the efficacy of gross total resection (GTR) and GTR plus adjuvant radiotherapy (RT) for WHO grade 2 meningiomas, adhering to PRISMA guidelines. It excludes irrelevant studies, conducts a thorough search until January 2024, and specifically analyzes overall survival (OS) and progression-free survival (PFS) outcomes for WHO grade 2 meningiomas. Statistical analysis adopts a two-stage approach with the R package "IPDfromKM," and quality assessment is conducted using the ROBINS-I tool.

RESULTS

In our analysis of 23 studies involving 3822 WHO grade 2 meningioma patients, GTR + RT resulted in a significantly longer PFS (HR: 0.849, 95% CI: 0.730 to 0.988, p = 0.035) compared to GTR alone. Although OS trended better with GTR + RT (HR: 0.79, 95% CI: 0.57 to 1.11, p = 0.173), the difference was not statistically significant, suggesting the need for further investigation.

CONCLUSION

Our study reveals a benefit to adjuvant RT for improving PFS for WHO grade 2 meningiomas. Integrating molecular characteristics into treatment strategies will refine the management of these tumors in the future.

摘要

引言

世界卫生组织（WHO）2级脑膜瘤在诊断和治疗方面存在挑战。手术，尤其是全切除（GTR）至关重要，术后常需辅助放疗（RT）；然而，对于GTR术后是否进行放疗，临床上存在权衡，相关随机试验仍在进行。

方法

本系统评价遵循PRISMA指南，评估全切除（GTR）及GTR联合辅助放疗（RT）对WHO 2级脑膜瘤的疗效。排除无关研究，进行全面检索至2024年1月，并特别分析WHO 2级脑膜瘤的总生存期（OS）和无进展生存期（PFS）结果。采用R包“IPDfromKM”进行两阶段统计分析，使用ROBINS-I工具进行质量评估。

结果

在我们对涉及3822例WHO 2级脑膜瘤患者的23项研究的分析中，与单纯GTR相比，GTR + RT的PFS显著延长（HR：0.849，95% CI：0.730至0.988，p = 0.035）。虽然GTR + RT的OS有改善趋势（HR：0.79，95% CI：0.57至1.11，p = 0.173），但差异无统计学意义，提示需要进一步研究。