■在患有局限期小细胞肺癌(LS-SCLC)的患者中使用预防性颅骨照射(PCI)在现代脑磁共振成像(MRI)分期中仍然存在争议。为此,我们在此进行了一项系统综述和荟萃分析,以调查这些患者的总生存期(OS).
■对PubMed和EMBASE数据库的相关研究进行了综述,并使用固定效应模型获得集合危险风险。使用了PRISMA2020清单。
■确定了15项回顾性研究,共有2,797例LS-SCLC患者纳入分析,其中1,391人接受了PCI。对于所有纳入的患者,PCI与OS改善相关[风险比(HR):0.64,95%置信区间(CI):0.58-0.70]。亚组分析和敏感性分析相结合,提示PCI对OS的影响独立于原发肿瘤治疗,完全反应比例(CR),中位年龄,PCI剂量,出版年,等。此外,重建了8项研究中1,588例接受胸部放疗(TRT)作为主要肿瘤治疗的患者的OS曲线,和汇集的2-,局限期患者的3年和5年OS率为59%,而非42%,42%vs.29%和26%与PCI组和非PCI组的19%(HR:0.69,95%CI:0.61-0.77),分别。从2项研究中重建的339例接受根治性手术作为原发肿瘤治疗的患者的OS曲线显示出更好的结果。和汇集的2-,PCI组和非PCI组的3年和5年OS率分别为85%和85%。71%,70%vs.56%和52%vs.39%(HR:0.59,95%CI:0.40-0.87),分别。
■这项荟萃分析表明,在现代预处理MRI分期中,PCI对LS-SCLC患者的OS具有显着的有益作用。然而,考虑到大多数纳入研究的对照组没有指南建议的严格的脑MRI随访,PCI相对于无PCI加脑MRI监测的治疗策略的优越性尚不清楚.
UNASSIGNED: The use of prophylactic cranial irradiation (PCI) in patients suffering from limited-stage small-cell lung cancer (LS-SCLC) remains controversial in modern brain magnetic resonance imaging (MRI) staging. To this end, a systematic
review with meta-analysis was hereby performed to investigate the overall survival (OS) in these patients.
UNASSIGNED: Relevant studies from the PubMed and EMBASE databases were reviewed, and pooled hazard risks were obtained using fixed-effects models. The PRISMA 2020 checklist was used.
UNASSIGNED: Fifteen retrospective studies were identified, with a total of 2,797 patients with LS-SCLC included in the analysis, 1,391 of which had received PCI. For all included patients, PCI was associated with improved OS [hazard ratio (HR): 0.64, 95% confidence interval (CI): 0.58-0.70]. The combination of subgroup analysis and sensitivity analysis suggested that the effect of PCI on OS was independent of primary tumor treatment, proportion of complete response (CR), median age, PCI dose, publication years, etc. Additionally, the OS curve of 1,588 patients having undergone thoracic radiotherapy (TRT) as the primary tumor treatment from 8 studies were reconstructed, and the pooled 2-, 3- and 5-year OS rates of limited stage patients were 59% vs. 42%, 42% vs. 29% and 26% vs. 19% (HR: 0.69, 95% CI: 0.61-0.77) in the PCI group and the no PCI group, respectively. Another reconstructed OS curve of 339 patients having undergone radical surgery as the primary tumor treatment from 2 studies presented better results, and the pooled 2-, 3- and 5-year OS rates of in the PCI group and the no PCI group were 85% vs. 71%, 70% vs. 56% and 52% vs. 39% (HR: 0.59, 95% CI: 0.40-0.87), respectively.
UNASSIGNED: This meta-analysis demonstrates a significant beneficial effect of PCI on the OS in patients with LS-SCLC in modern pretreatment MRI staging. However, considering the absence of a strict follow-up of brain MRI recommended by the guideline for the control group from most of the included studies, the superiority of PCI to the treatment strategy of no PCI plus brain MRI surveillance remains unclear.