背景:化疗是妊娠滋养细胞肿瘤(GTN)的推荐治疗方法。提倡第二次刮治,以避免不必要的化疗和减少化疗的疗程;然而,尚未达成共识,因为有论点声称它无法诱导完全回归。
目的:本研究旨在阐明第二次刮宫术对避免不必要的化疗和减少后磨牙GTN患者化疗疗程的有效性。
方法:搜索了七个主要的电子数据库,包括四个英文数据库和三个中文数据库,从每个数据库开始到2023年1月31日。
方法:如果研究是:(1)人类,(2)明确表示暴露于第二次刮宫,(3)明确表示控制常规化疗,(4)明确表示参与者是妊娠滋养细胞肿瘤(GTN)患者,和(5)将感兴趣的结果作为化疗疗程的数量进行比较。
方法:两位作者独立提取和分析数据。第三作者通过审查全文来调和分歧。研究地点的数据,数据收集,研究设计,参与人数,干预策略,控制策略,后续阶段,结果,对不良事件进行分析.
结果:关于避免不必要的化疗,与常规化疗组相比,第二次刮宫组的总体合并效应大小具有显著优势,OR为0.02(95%CI:0.00~0.06).同时,为了减少化疗疗程的数量,与常规化疗组相比,第二次刮宫组的总体合并效应大小具有显著优势,平均差异为-2.11(95%CI:-3.72~-0.51).
结论:第二刮宫组在避免不必要的化疗和减少化疗疗程数上比常规化疗组有显著优势。应进行更多更大的多中心随机对照试验,以证实我们的结果,并明确磨牙后GTN患者第二次刮治的最佳患者组。
BACKGROUND: Chemotherapy is the recommended treatment for gestational trophoblastic neoplasia (GTN). Second curettage had been advocated to avoid unnecessary chemotherapy and to reduce the courses of chemotherapy; however, consensus has not been reached as there are arguments claiming its inability of inducing complete regression.
OBJECTIVE: The present study was performed to clarify the effectiveness of second curettage for avoiding unnecessary chemotherapy and lowering the number of chemotherapy courses in patients with post-molar GTN.
METHODS: Seven predominant electronic databases were searched, including four English databases and three Chinese databases, from the inception of each database until January 31, 2023.
METHODS: Studies were included if they were: (1) human, (2) explicitly indicated exposure to second curettage, (3) explicitly indicated control to conventional chemotherapy, (4) explicitly indicated the participants were patients with gestational trophoblastic neoplasia (GTN), and (5) compared the outcome of interest as the number of the course of chemotherapy.
METHODS: Two authors extracted and analyzed the data independently. Disagreements were reconciled by reviewing the full text by a third author. The data of study location, data collection, study design, number of participants, intervention strategy, control strategy, the follow-up period, outcome, adverse events were analyzed.
RESULTS: With regard to avoiding unnecessary chemotherapy, the overall pooled effect size of the second curettage group had a significant advantage over the conventional chemotherapy group with an OR of 0.02 (95% CI: 0.00-0.06). Meanwhile, for reducing the number of chemotherapy courses, the overall pooled effect size of the second curettage group had significant advantage over the conventional chemotherapy group with a mean difference of -2.11 (95% CI: -3.72 to -0.51).
CONCLUSIONS: The second curettage group had a significant advantage over the conventional chemotherapy group in avoiding unnecessary chemotherapy and reducing the number of chemotherapy courses. Further larger multi-center randomized controlled trials should be conducted to confirm our results and to clarify the optimal patients\' group for second curettage in patients with post-molar GTN.