背景:比较留置胸膜导管(IPC)与全身癌症治疗(SCT)时机相关的疗效和安全性(即,之前,during,或SCT后)恶性胸腔积液(MPE)患者。
方法:随机对照试验(RCT)的系统评价,准对照试验,前瞻性和回顾性队列,以及超过20名患者的病例系列,其中提供了与SCT相关的IPC插入时间。Medline(通过PubMed),Embase,从成立到2023年1月,对Cochrane图书馆进行了系统搜索。使用Cochrane偏差风险(ROB)工具对RCT进行评估,并在非随机设计的非随机干预研究(ROBINS-I)中使用ROB进行评估。
结果:纳入了10项研究(n=2907例;3066例IPCs)。使用SCT而IPC原位降低了总死亡率,增加生存时间,并提高了质量调整后的生存率。SCT的时间对IPC相关感染的风险没有影响(总体为2.85%),即使在中度或重度中性粒细胞减少的免疫功能低下患者中(IPC和SCT联合治疗的患者的相对危险度为0.98[95CI:0.93-1.03]).结果的不一致或缺乏对与SCT/IPC时间安排有关的所有结果指标的分析,无法得出关于IPC移除时间或需要重新干预的可靠结论。
结论:根据观察证据,IPC用于MPE的有效性和安全性似乎不会因IPC插入时间而异(之前,during,或在SCT之后)。数据很可能支持早期IPC插入。
BACKGROUND: To compare the efficacy and safety of indwelling pleural catheters (IPC) in relation with the timing of systemic cancer therapy (SCT) (i.e., before, during, or after SCT) in patients with malignant pleural effusion (MPE).
METHODS: Systematic
review of randomized controlled trials (RCT), quasi-controlled trials, prospective and retrospective cohorts, and case series of over 20 patients, in which the timing of IPC insertion in relation to that of SCT was provided. Medline (via PubMed), Embase, and Cochrane Library were systematically searched from inception to January 2023. The risk of bias was assessed using the Cochrane Risk of Bias (ROB) tool for RCTs and the ROB in non-randomized studies of interventions (ROBINS-I) for non-randomized designs.
RESULTS: Ten studies (n=2907 patients; 3066 IPCs) were included. Using SCT while the IPC was in situ decreased overall mortality, increased survival time, and improved quality-adjusted survival. Timing of SCT had no effect on the risk of IPC-related infections (2.85% overall), even in immunocompromised patients with moderate or severe neutropenia (relative risk 0.98 [95%CI: 0.93-1.03] for patients treated with the combination of IPC and SCT). The inconsistency of the results or the lack of analysis of all outcome measures in relation to the SCT/IPC timing precluded drawing solid conclusions about time to IPC removal or need of re-interventions.
CONCLUSIONS: Based on observational evidence, the efficacy and safety of IPC for MPE does not seem to vary depending on the IPC insertion timing (before, during, or after SCT). The data most likely support early IPC insertion.