Peng Qili, Lu Yi, Huang Renhua, Chen Rui
Department of Plastic and Reconstructive Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
Department of Radiotherapy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
Aesthetic Plast Surg. 2025 May 9. doi: 10.1007/s00266-025-04869-x.
There is no consensus on the timing of postoperative radiotherapy for keloid.
We conducted this meta-analysis to investigate the appropriate time of radiotherapy for keloid in the first 24 hours after operation and identify the potential risk factors.
A systematic review and meta-analysis were conducted on observational studies by searching PubMed, Embase, and the Cochrane Library. The pooled estimate of the keloid recurrence rate was calculated using a random-effects model. Subgroup analyses were conducted based on time, overtime, BED, length, and location of keloid.
Eight observational studies with 507 keloids met the inclusion criteria, and 7 studies were finally included in this study after sensitivity analysis. The recurrence rate was lower in the 2 hours postoperative radiotherapy group (7% CI 2-14%) than in the 6 hours postoperative radiotherapy group (16%, CI 3-36%) (P<0.01). In HDR subgroup analysis, the 2 hours group was better than the 6 hours group ((5%, CI 1-14%) versus (16%, CI 3-36.1%) (P<0.01). Subgroup analysis based on BED indicated that the BED 30 group (5%, CI 1-14%) had a lower recurrence rate than the BED 20 group (6%, CI 0-21%) and the BED 15 group (26%, CI 19-33%) (P<0.01). The keloid length >5 cm subgroup (10.4%, CI 0.4-29%) showed a higher recurrence rate than the keloid length <5 cm group (9.9%, CI 0-41%) (P=0.011).
Immediate postoperative radiotherapy within 2 hours significantly decreased recurrence rate than postoperative radiotherapy within 6 hours.
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瘢痕疙瘩术后放疗的时机尚无共识。
我们进行这项荟萃分析，以研究瘢痕疙瘩术后24小时内放疗的合适时间，并确定潜在风险因素。
通过检索PubMed、Embase和Cochrane图书馆对观察性研究进行系统评价和荟萃分析。使用随机效应模型计算瘢痕疙瘩复发率的合并估计值。基于时间、超时、生物等效剂量（BED）、瘢痕疙瘩长度和位置进行亚组分析。
八项涉及507个瘢痕疙瘩的观察性研究符合纳入标准，经过敏感性分析后最终有7项研究纳入本研究。术后2小时放疗组的复发率（7%，95%置信区间2%-14%）低于术后6小时放疗组（16%，95%置信区间3%-36%）（P<0.01）。在高剂量率（HDR）亚组分析中，2小时组优于6小时组（（5%，95%置信区间1%- 14%）对（16%，95%置信区间3%-36.1%）（P<0.01）。基于BED的亚组分析表明，BED 30组（5%，95%置信区间1%-14%）的复发率低于BED 20组（6%，95%置信区间0%-21%）和BED 15组（26%，95%置信区间19%-33%）（P<0.01）。瘢痕疙瘩长度>5 cm亚组（10.4%，95%置信区间0.4%-29%）的复发率高于瘢痕疙瘩长度<5 cm组（9.9%，95%置信区间0%-41%）（P=0.011）。
术后2小时内立即放疗比术后6小时放疗显著降低复发率。
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