■纤维瘤病(DF)是一种局部侵袭性肿瘤,其特征是肿瘤细胞周围浸润和远处转移障碍。本系统评价了热消融治疗DF肿瘤的疗效和安全性。
■使用PubMed进行了文献检索,WebofScience,科克伦图书馆,和Embase从2000年1月1日至2022年11月12日。系统审查和荟萃分析(PRISMA)的首选报告项目用于指导文献选择。纳入标准如下:(I)患者病理诊断为侵袭性纤维瘤病,(二)患者接受热消融治疗,(III)关注治疗效果和安全性。同时,排除标准如下:(I)增生性瘢痕患者队列,加德纳纤维瘤,或结节性筋膜炎;(二)会议摘要,reviews,病例报告,给编辑的信,注释,或社论;(III)患者人数<5;(IV)体外或动物实验;(V)非英语文章。使用具有随机效应模型的逆方差方法来获得合并数据。进行亚组分析以确定治疗因素。进行Egger测试以评估发表偏倚的风险。
■在文献选择之后,在23项研究中鉴定出694例DF肿瘤。就模态而言,13项研究使用冷冻消融,9项研究使用高强度聚焦超声(HIFU),1项研究采用微波消融(MWA)。合并症状缓解率为90%[95%置信区间(CI):80-97%],HIFU为100%(95%CI:85-100%),冷冻消融为87%(95%CI:74-97%),MWA为89%(95%CI)。合并的主要并发症发生率为3%(95%CI:1-7%),每种模式的HIFU=2%(95%CI:0-6%),冷冻消融=4%(95%CI:1-8%),MWA=11%,超声=6%(95%CI:1-13%),计算机断层扫描(CT)=2%(95%CI:0-7%),磁共振成像(MRI)=3%(95%CI:0-14%)。合并非灌注体积率(NPVR)为76%(95%CI:71-81%),每种模式的HIFU=77%(95%CI:71-85%),冷冻消融=74%(95%CI:69-79%),超声=75%(95%CI:67-83%),CT=76%(95%CI:67-87%),MRI=78%(95%CI:70-87%)。合并的局部控制率为88%(95%CI:79-94%),每种方式的控制率如下:HIFU=99%(95%CI:96-100%),冷冻消融=80%(95%CI:68-90%),MWA=78%。在主要并发症发生率(P=0.77)和NPVR之间的成像引导模式(P=0.40)差异无统计学意义。消融技术之间的症状缓解率(P=0.32)和主要并发症发生率(P=0.61)也没有差异;然而,消融技术之间的局部控制率差异有统计学意义(P=0.01)。
■成像引导热消融治疗有助于症状缓解,持续时间超过6个月,DF肿瘤的主要并发症发生率低。
UNASSIGNED: Desmoid-type fibromatosis (DF) is a locally aggressive tumor characterized by peripheral infiltration of neoplastic cells and remote metastasis disability. This systematic review examined the efficacy and safety of thermal ablative therapy for DF tumors.
UNASSIGNED: A literature search was conducted using PubMed, Web of Science, Cochrane Library, and Embase from January 1, 2000, to November 12, 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to guide literature selection. The inclusion criteria were the following: (I) the patients were diagnosed with aggressive fibromatosis pathologically, (II) the patients were treated by thermal ablations, and (III) a focus on treatment efficacy and safety. Meanwhile, the exclusion criteria were the following: (I) cohorts of patients with hypertrophic scar, Gardner fibroma, or nodular fasciitis; (II) conference abstracts, reviews, case reports, letters to editors, comments, or editorials; (III) number of patients <5; (IV) in vitro or animal experiments; and (V) non-English language articles. The inverse variance method with a random effects model was used to obtain the pooled data. Subgroup analyses were performed to identify treatment factors. Egger test was conducted to assess the risk of publication bias.
UNASSIGNED: After literature selection, 694 DF tumors were identified in 23 studies. In terms of modality, 13 studies used cryoablation, 9 studies used high-intensity focused ultrasound (HIFU), and 1 study used microwave ablation (MWA). The pooled symptom relief rate was 90% [95% confidence interval (CI): 80-97%], with that for HIFU being 100% (95% CI: 85-100%), that for cryoablation being 87% (95% CI: 74-97%), and that MWA being 89% (95% CI). The pooled major complication rate was 3% (95% CI: 1-7%), and that for each modality was as follows: HIFU =2% (95% CI: 0-6%), cryoablation =4% (95% CI: 1-8%), MWA =11%, ultrasound =6% (95% CI: 1-13%), computed tomography (CT) =2% (95% CI: 0-7%), and magnetic resonance imaging (MRI) =3% (95% CI: 0-14%). The pooled nonperfused volume rate (NPVR) was 76% (95% CI: 71-81%), and that for each modality was as follows: HIFU =77% (95% CI: 71-85%), cryoablation =74% (95% CI: 69-79%), ultrasound =75% (95% CI: 67-83%), CT =76% (95% CI: 67-87%), and MRI =78% (95% CI: 70-87%). The pooled local control rate was 88% (95% CI: 79-94%) and that for each modality was as follows: HIFU =99% (95% CI: 96-100%), cryoablation =80% (95% CI: 68-90%), and MWA =78%. The differences in major complication rate (P=0.77) and NPVR between imaging-guided modalities (P=0.40) were not significant, nor were the differences in symptom relief rate (P=0.32) and major complication rate (P=0.61) between ablative techniques; however, the differences in local control rate (P=0.01) were significant between ablative techniques.
UNASSIGNED: Imaging-guided thermal ablative therapies contribute to symptom relief with a duration of more than 6 months and a low major complication rate of DF tumors.