PDF(Pubmed)
Abstract：
UNASSIGNED: Patients with small cell lung cancer (SCLC) are at high risk for brain metastases. Prophylactic cranial irradiation (PCI) is recommended in this population to reduce the incidence of brain metastases and prolong survival. We aimed to assesses the efficacy of PCI in this population in the era of routine brain imaging. To our knowledge, this is the first systematic review and meta-analysis to examine the use among patients who were radiographically confirmed not to have brain metastases after completion of first-line therapy.
UNASSIGNED: In this systematic review and meta-analysis, cohort studies and controlled trials reporting on the use of PCI for patients SCLC were identified in EMBASE, MEDLINE, CENTRAL, and grey literature sources. The literature search was conducted on November 12, 2023. Summary data were extracted. Random-effects meta-analyses pooled hazard ratios (HR) for the primary outcome of overall survival between PCI and no intervention groups. This study is registered with the Open Science Framework, DOI:10.17605/OSF.IO/BC359, and PROSPERO, CRD42021249466.
UNASSIGNED: Of 4318 identified records, 223 were eligible for inclusion. 109 reported on overall survival in formats amenable to meta-analysis; PCI was associated with longer survival in all patients with SCLC (HR 0.59; 95% CI, 0.55-0.63; p < 0.001; n = 56,770 patients), patients with limited stage disease (HR 0.60; 95% CI, 0.55-0.65; p < 0.001; n = 78 studies; n = 27,137 patients), and patients with extensive stage disease (HR 0.59; 95% CI, 0.51-0.70; p < 0.001; n = 28 studies; n = 26,467 patients). Between-study heterogeneity was significant when pooled amongst all studies (I2 = 73.6%; 95% CI 68.4%-77.9%). Subgroup analysis did not reveal sources of heterogeneity. In a subgroup analysis on studies that used magnetic resonance imaging to exclude presence of brain metastases at restaging among all patients, overall survival did not differ significantly between patients who did or did not receive PCI (HR 0.74; 95% CI, 0.52-1.05; p = 0.08; n = 9 studies; n = 1384 patients).
UNASSIGNED: Our findings suggested that administration of PCI is associated with a survival benefit, but not when considering studies that radiographically confirmed absence of brain metastases, suggesting that the survival benefit conferred by PCI might be therapeutic rather than prophylactic.
UNASSIGNED: No funding.
UNASSIGNED: In this systematic review and meta-analysis, cohort studies and controlled trials reporting on the use of PCI for patients SCLC were identified in EMBASE, MEDLINE, CENTRAL, and grey literature sources. The literature search was conducted on November 12, 2023. Summary data were extracted. Random-effects meta-analyses pooled hazard ratios (HR) for the primary outcome of overall survival between PCI and no intervention groups. This study is registered with the Open Science Framework, DOI:10.17605/OSF.IO/BC359, and PROSPERO, CRD42021249466.
UNASSIGNED: Of 4318 identified records, 223 were eligible for inclusion. 109 reported on overall survival in formats amenable to meta-analysis; PCI was associated with longer survival in all patients with SCLC (HR 0.59; 95% CI, 0.55-0.63; p < 0.001; n = 56,770 patients), patients with limited stage disease (HR 0.60; 95% CI, 0.55-0.65; p < 0.001; n = 78 studies; n = 27,137 patients), and patients with extensive stage disease (HR 0.59; 95% CI, 0.51-0.70; p < 0.001; n = 28 studies; n = 26,467 patients). Between-study heterogeneity was significant when pooled amongst all studies (I2 = 73.6%; 95% CI 68.4%-77.9%). Subgroup analysis did not reveal sources of heterogeneity. In a subgroup analysis on studies that used magnetic resonance imaging to exclude presence of brain metastases at restaging among all patients, overall survival did not differ significantly between patients who did or did not receive PCI (HR 0.74; 95% CI, 0.52-1.05; p = 0.08; n = 9 studies; n = 1384 patients).
UNASSIGNED: Our findings suggested that administration of PCI is associated with a survival benefit, but not when considering studies that radiographically confirmed absence of brain metastases, suggesting that the survival benefit conferred by PCI might be therapeutic rather than prophylactic.
UNASSIGNED: No funding.
摘要：
■小细胞肺癌（SCLC）患者脑转移的风险很高。建议在该人群中进行预防性颅骨照射（PCI），以减少脑转移的发生率并延长生存期。我们旨在评估常规脑成像时代PCI在该人群中的疗效。据我们所知,这是首次系统评价和荟萃分析,目的是研究在完成一线治疗后经影像学检查证实未发生脑转移的患者中的使用情况.
■在本系统综述和荟萃分析中，在EMBASE中确定了对SCLC患者使用PCI的队列研究和对照试验，MEDLINE,中部,和灰色文献来源。文献检索于2023年11月12日进行。提取汇总数据。随机效应荟萃分析了PCI和无干预组之间总生存期的主要结局的风险比（HR）。这项研究在开放科学框架中注册，DOI:10.17605/OSF.IO/BC359和PROSPERO，CRD42021249466。
■在确定的4318条记录中，223人有资格入选。109例报告了符合荟萃分析格式的总生存率；PCI与所有SCLC患者的生存期更长相关（HR0.59；95％CI，0.55-0.63；p<0.001；n=56,770例），局限期疾病患者(HR0.60;95%CI,0.55-0.65;p<0.001;n=78项研究;n=27,137例患者),和广泛期疾病患者(HR0.59;95%CI,0.51-0.70;p<0.001;n=28项研究;n=26,467例)。在所有研究中汇总时，研究之间的异质性是显着的（I2=73.6％；95％CI68.4％-77.9％）。亚组分析没有揭示异质性的来源。在对使用磁共振成像来排除所有患者在重诊时脑转移的研究的亚组分析中，接受或未接受PCI的患者的总生存期无显著差异(HR0.74;95%CI,0.52-1.05;p=0.08;n=9项研究;n=1384例).
■我们的研究结果表明，PCI治疗与生存获益相关，但当考虑到影像学证实没有脑转移的研究时，提示PCI带来的生存获益可能是治疗性的,而非预防性的.
■没有资金。
■在本系统综述和荟萃分析中，在EMBASE中确定了对SCLC患者使用PCI的队列研究和对照试验，MEDLINE,中部,和灰色文献来源。文献检索于2023年11月12日进行。提取汇总数据。随机效应荟萃分析了PCI和无干预组之间总生存期的主要结局的风险比（HR）。这项研究在开放科学框架中注册，DOI:10.17605/OSF.IO/BC359和PROSPERO，CRD42021249466。
■在确定的4318条记录中，223人有资格入选。109例报告了符合荟萃分析格式的总生存率；PCI与所有SCLC患者的生存期更长相关（HR0.59；95％CI，0.55-0.63；p<0.001；n=56,770例），局限期疾病患者(HR0.60;95%CI,0.55-0.65;p<0.001;n=78项研究;n=27,137例患者),和广泛期疾病患者(HR0.59;95%CI,0.51-0.70;p<0.001;n=28项研究;n=26,467例)。在所有研究中汇总时，研究之间的异质性是显着的（I2=73.6％；95％CI68.4％-77.9％）。亚组分析没有揭示异质性的来源。在对使用磁共振成像来排除所有患者在重诊时脑转移的研究的亚组分析中，接受或未接受PCI的患者的总生存期无显著差异(HR0.74;95%CI,0.52-1.05;p=0.08;n=9项研究;n=1384例).
■我们的研究结果表明，PCI治疗与生存获益相关，但当考虑到影像学证实没有脑转移的研究时，提示PCI带来的生存获益可能是治疗性的,而非预防性的.
■没有资金。
