METHODS: A comprehensive systematic search was performed in PubMed, EMBASE, Cochrane Library, and Web of Science databases. Studies comparing overall survival (OS) and recurrence-free survival (RFS) of patients who underwent AT or not following AmC resection were included.
RESULTS: A total of 3971 patients in 21 studies were analyzed. Overall pooled data showed no significant difference in effect on the OS by AT [hazard ratio (HR) = 0.998, 95% confidence interval (CI): 0.768-1.297]. No significant difference in recurrence between the AT and non-AT (nAT) groups was noted (HR = 1.158, 95% CI: 0.764-1.755). In subgroup analysis, patients who received AT showed favorable outcomes in the OS compared with those who received nAT in nodal-positive AmC (HR = 0.627, 95% CI: 0.451-0.870). Neither AT consisted of adjuvant chemotherapy with radiotherapy (HR = 0.804, 95% CI: 0.563-1.149) nor AT with adjuvant chemotherapy (HR = 0.883, 95% CI: 0.642-1.214) showed any significant effect on the OS.
CONCLUSIONS: The effect of AT in AmC on survival and recurrence did not show a significant benefit. Furthermore, effectiveness according to AT strategies did not show enhancement in survival. AT had an advantage in survival compared with nAT strategy in nodal-positive AmC. In cases of AmC with positive lymph nodal involvement, AT may be warranted regardless of detailed strategies.
方法:在PubMed中进行了全面的系统搜索,EMBASE,科克伦图书馆,和WebofScience数据库。包括比较AmC切除术后接受AT或未接受AT的患者的总生存期(OS)和无复发生存期(RFS)的研究。
结果:共分析了21项研究中的3971例患者。总体汇总数据显示AT对OS的影响没有显着差异[风险比(HR)=0.998,95%置信区间(CI):0.768-1.297]。AT和非AT(nAT)组之间的复发没有显着差异(HR=1.158,95%CI:0.764-1.755)。在亚组分析中,与在淋巴结阳性AmC中接受nAT的患者相比,接受AT的患者在OS方面表现出良好的结局(HR=0.627,95%CI:0.451~0.870).AT包括辅助化疗和放疗(HR=0.804,95%CI:0.563-1.149)和AT联合辅助化疗(HR=0.883,95%CI:0.642-1.214)均未显示对OS的显着影响。
结论:AT在AmC中对生存和复发的影响没有显示出显著的益处。此外,根据AT策略的有效性未显示生存率的提高.与nAT策略相比,在淋巴结阳性AmC中,AT在生存方面具有优势。在淋巴结受累阳性的AmC病例中,无论详细的策略如何,都可能需要AT。