Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Thorac Cancer. 2024 Nov;15(32):2309-2318. doi: 10.1111/1759-7714.15463. Epub 2024 Oct 9.
Prophylactic cranial irradiation (PCI) was recommended for limited-stage small-cell lung cancer (SCLC) patients with complete or partial response to primary chemoradiotherapy. But it is still controversial regarding its role in SCLC patients who have had radical resection. This meta-analysis aims to evaluate the efficacy of PCI in resected SCLC patients. We searched PubMed, EMBASE, Web of Science, CENTRAl, and ClinicalTrials for controlled trials and cohort studies regarding PCI in postoperative SCLC patients. The correlation between PCI and post-operative outcomes in SCLC patients, including survival and brain metastasis rate (BMR), was examined using hazard ratios (HRs) and risk ratios with corresponding 95% confidence intervals. Quality of studies was assessed by the Newcastle-Ottawa Scale (NOS), and publication bias was assessed by Begg's test. Meta-analysis of eight studies with 2688 patients in total showed PCI was associated with improved overall survival (OS) for resected SCLC (HR: 0.65, 95% CI: 0.57-0.75, p < 0.01). In addition, subgroup analysis on three studies including 923 patients confirmed the protective role of postoperative PCI in N0 SCLC patients (HR: 0.79, 95% CI: 0.61-0.97, p < 0.05). There was also a significant reduction in BMR in the PCI group pooled from six studies (HR: 0.58, 95% CI: 0.40-0.85, p < 0.01). The use of PCI delayed brain recurrence and improved OS in patients with resected, stage I-III SCLC. Importantly, patients with N0 SCLC can also benefit from postoperative PCI. In future studies, PCI's role in patients with resected N0 SCLC at different T stage may need to be explored.
预防性颅照射（PCI）被推荐用于对原发放化疗有完全或部分缓解的局限期小细胞肺癌（SCLC）患者。但是，对于已经接受根治性切除的 SCLC 患者，PCI 的作用仍存在争议。本荟萃分析旨在评估 PCI 在接受根治性切除的 SCLC 患者中的疗效。我们检索了 PubMed、EMBASE、Web of Science、CENTRAL 和 ClinicalTrials 中有关 SCLC 术后 PCI 的对照试验和队列研究。使用风险比（HRs）和相应的 95%置信区间（CI），评估 PCI 与 SCLC 患者术后生存和脑转移率（BMR）等结局之间的相关性。使用纽卡斯尔-渥太华量表（NOS）评估研究质量，采用贝叶斯检验评估发表偏倚。对 8 项总计 2688 例患者的研究进行荟萃分析显示，PCI 可改善切除后的 SCLC 患者的总生存（OS）（HR：0.65，95%CI：0.57-0.75，p<0.01）。此外，对纳入 923 例患者的 3 项研究的亚组分析证实，术后 PCI 对 N0 SCLC 患者具有保护作用（HR：0.79，95%CI：0.61-0.97，p<0.05）。6 项研究汇总结果显示，PCI 组的 BMR 显著降低（HR：0.58，95%CI：0.40-0.85，p<0.01）。PCI 可延迟脑复发并改善 I-III 期 SCLC 切除术后患者的 OS。重要的是，N0 SCLC 患者也可从术后 PCI 中获益。在未来的研究中，可能需要探讨 PCI 在不同 T 分期的 N0 SCLC 患者中的作用。
