背景:在原发性局部可切除腹膜后肉瘤(RPS)中,尽管进行了最佳的手术治疗,但仍经常发生局部区域和远处复发。化疗在改善预后中的作用尚不清楚。
方法:进行了系统评价,利用人口,干预,比较结果(PICO)模型,评估新辅助或辅助化疗是否能改善原发性局部可切除RPS成人的预后。Medline,从1946年到2022年6月,Embase和CochraneCentral被问及评估无复发生存率的出版物。总生存率,和术后并发症。每个研究都由两名独立的审阅者筛选适合性。对结果进行定性合成。
结果:确定了23项研究;一项回顾性研究的荟萃分析和22项回顾性研究,包括3项倾向匹配队列。大多数研究没有通过组织学分析结果,详细的治疗方案,提供接受化疗的患者的基线特征或选择标准。在几项研究中说明了选择偏倚的证据。Newcastle-Ottawa回顾性队列研究12项研究质量良好,10项研究质量较差。所有研究均被澳大利亚NHMRC等级评估为III-2级证据。总的来说,在手术中增加新辅助或辅助化疗与局部复发的改善无关,无转移生存率,原发性局部可切除RPS的无病生存期或总生存期。有一些证据表明化疗与较差的总体生存率有关。一项单中心研究表明,与单纯手术相比,新辅助化疗与原发性局部可切除RPS的术后并发症增加无关。
结论:目前没有证据表明在手术中加入化疗可以改善原发性局部可切除RPS的成年患者的预后。现有证据因其回顾性性质和选择偏倚的可能性高而受到限制,通常对复发风险较高的患者和许多未在高容量肉瘤中心接受治疗的患者进行化疗。需要随机试验来最终确定化疗在原发性局部可切除RPS中的作用。
BACKGROUND: In primary localised resectable retroperitoneal sarcoma (RPS), loco-regional and distant relapse occur frequently despite optimal surgical management. The role of chemotherapy in improving outcomes is unclear.
METHODS: A systematic review was conducted, using the population, intervention, comparison outcome (PICO) model, to evaluate whether neoadjuvant or adjuvant chemotherapy improve outcomes in adults with primary localised resectable RPS. Medline, Embase and Cochrane Central were queried for publications from 1946 to June 2022 that evaluated recurrence free survival, overall survival, and post operative complications. Each study was screened by two independent reviewers for suitability. A qualitative synthesis of the results was performed.
RESULTS: Twenty three studies were identified; one meta-analysis of retrospective studies and 22 retrospective studies including three with propensity matched cohorts. Most studies did not analyse outcomes by histology, detail treatment regimens, provide baseline characteristics or selection criteria for those receiving chemotherapy. Evidence of selection bias was illustrated in several studies. Newcastle-Ottawa quality of retrospective cohort studies was good for 12 studies and poor for 10 studies. All studies were assessed as Level III-2 evidence by the Australian NHMRC hierarchy. Overall, the addition of neoadjuvant or adjuvant chemotherapy to surgery was not associated with improvement in local recurrence, metastasis free survival, disease free survival or overall survival in primary localised resectable RPS. There is some evidence of an association of chemotherapy with worse overall survival. One single centre study showed that neoadjuvant chemotherapy was not associated with increased post operative complications compared to surgery alone in primary localised resectable RPS.
CONCLUSIONS: There is currently no evidence that demonstrates the addition of chemotherapy to surgery improves outcomes in adult patients with primary localised resectable RPS. Available evidence is limited by its retrospective nature and high likelihood of selection bias with chemotherapy generally administered to patients at higher risk of recurrence and many patients not receiving care in high volume sarcoma centres. Randomised trials are required to conclusively determine the role of chemotherapy in primary localised resectable RPS.