预防性放疗降低恶性胸膜间皮瘤有创操作通道转移发生率的Meta分析

刘雪; 黄月; 谭春燕; 任庆兰

doi:10.3971/j.issn.1000-8578.2018.17.1267

预防性放疗降低恶性胸膜间皮瘤有创操作通道转移发生率的Meta分析

Prophylactic Radiotherapy for Procedure Tract Metastases in Malignant Pleural Mesothelioma: A Meta-analysis

摘要

摘要:
目的系统评价预防性放疗能否降低恶性胸膜间皮瘤（MPM）有创操作通道转移（PTMs）发生率。
方法检索PubMed、Cochrane Library、Web of Science、Embase数据库，收集MPM有创操作通道进行预防性放疗的相关研究，由两位评价员独立筛选文献、提取资料并评价纳入研究的方法学质量后，采用RevMan5.3软件进行Meta分析。
结果共纳入7项研究，包括698例患者。Meta分析结果显示，预防性放疗不能降低所有MPM患者PTMs的发生率（OR=0.48, 95%CI: 0.22~1.07, P=0.07）。而进行亚组分析后发现预防性放疗能有效减少进行大口径操作的MPM患者（OR=0.39, 95%CI: 0.18~0.84, P=0.02），或上皮型MPM患者（OR=0.21, 95%CI: 0.11~0.69, P=0.006）医源性PTMs的发生。
结论预防性放疗能有效预防进行开胸手术、胸腔镜、留置胸壁引流管等大口径操作或病理类型为上皮型MPM患者医源性PTMs的发生。

Abstract:
Objective To systematically evaluate if prophylactic radiotherapy could reduce the incidence of procedure tract metastases(PTMs) in patients with malignant pleural mesothelioma(MPM).
Methods Databases including PubMed, Cochrane Library, Web of Science, Embase were searched to collect studies about prophylactic radiotherapy for procedure tracts in MPM. Two reviewers independently screened literature, extracted data, and evaluated the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.3 software.
Results A total of seven studies involving 698 patients were included. Meta-analysis results showed that prophylactic radiotherapy could not reduce the incidence of PTMs in all MPM patients(OR=0.48, 95%CI: 0.22-1.07, P=0.07), but prophylactic radiotherapy could prevent PTMs in the subgroups of large bore procedures(OR=0.39, 95%CI: 0.18-0.84, P=0.02) and histologic type of epithelial MPM(OR=0.21, 95%CI: 0.11-0.69, P=0.006).
Conclusion The current evidence shows that prophylactic radiotherapy could prevent PTMs in MPM patients undergone large bore procedures(like thoracotomy, thoracoscopy, indwelling pleural catheter insertion) and patients with histologic type of epithelial MPM.

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