Association of the Extent of Resection With Survival in Glioblastoma: A Systematic Review and Meta-analysis.
Association of the Extent of Resection With Survival in Glioblastoma: A Systematic Review and Meta-analysis.
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DOI：
10.1001/jamaoncol.2016.1373
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发表时间：
2016-11-01
期刊：
影响因子：
28.4
通讯作者：
Glantz M
中科院分区：
文献类型：
--
作者：
Brown TJ;Brennan MC;Li M;Church EW;Brandmeir NJ;Rakszawski KL;Patel AS;Rizk EB;Suki D;Sawaya R;Glantz M
多形性胶质母细胞瘤（GBM）仍然几乎总是致命的，尽管最佳的手术和药物治疗。尽管有许多相关研究，但肿瘤切除程度（EOR）与预后之间的关系仍不明确。确定更大的EOR是否与GBM患者1年和2年总生存率以及6个月和1年无进展生存率的改善相关。Pubmed、CINAHL和Web of Science（1966年1月1日至2015年12月1日）在图书馆员的指导下进行了系统性综述。在咨询专家和评价参考文献后纳入了其他文章。文章收集时间为2015年1月15日至12月1日。纳入了新诊断的幕上GBM成人患者的研究，比较了各种EOR并提供了客观的总体或无进展生存数据。排除了儿科研究。数据由研究者从文章正文或Kaplan-Meier曲线中独立提取，研究者对彼此的结果不知情。分析数据以评估大体全切除（GTR）、次全切除（STR）和活检后的死亡率。根据建议评估、开发和评价分级（GRADE）标准和PRISMA指南对证据进行评价。1年和2年死亡率以及6个月和1年进展的相对风险（RR）。检索产生了37项适合纳入的研究（41117例独特患者）。荟萃分析显示，与STR相比，GTR在1年（RR，0.62; 95%CI，0.56 - 0.69; P <0.001;需要治疗的人数[NNT]，9）和2年（RR，0.84; 95%CI，0.79 - 0.89; P <0.001; NNT，17）时的死亡率降低。与活检相比，STR的1年死亡风险显著降低（RR，0. 85; 95% CI，0. 80 - 0. 91; P <0. 001）。与活检相比，任何切除术在1年（RR，0.77; 95%CI，0.71 - 0.84; P <0.001; NNT，21）和2年（RR，0.94; 95%CI，0.89 - 1.00; P = 0.04; NNT，593）时的死亡风险同样降低。与STR相比，GTR在6个月（RR，0.72; 95%CI，0.48 - 1.09; P = 0.12; NNT，14）和1年（RR，0.66; 95%CI，0.43 - 0.99; P <0.001; NNT，26）时疾病进展的可能性降低。根据GRADE标准，证据的质量为中等至低。该分析代表了迄今为止对该主题进行的最大系统性综述和唯一定量系统性综述。与STR相比，GTR显著改善了总体生存期和无进展生存期，但支持证据的质量为中等至低。
Glioblastoma multiforme (GBM) remains almost invariably fatal despite optimal surgical and medical therapy. The association between the extent of tumor resection (EOR) and outcome remains undefined, notwithstanding many relevant studies. To determine whether greater EOR is associated with improved 1- and 2-year overall survival and 6-month and 1-year progression-free survival in patients with GBM. Pubmed, CINAHL, and Web of Science (January 1, 1966, to December 1, 2015) were systematically reviewed with librarian guidance. Additional articles were included after consultation with experts and evaluation of bibliographies. Articles were collected from January 15 to December 1, 2015. Studies of adult patients with newly diagnosed supratentorial GBM comparing various EOR and presenting objective overall or progression-free survival data were included. Pediatric studies were excluded. Data were extracted from the text of articles or the Kaplan-Meier curves independently by investigators who were blinded to each other’s results. Data were analyzed to assess mortality after gross total resection (GTR), subtotal resection (STR), and biopsy. The body of evidence was evaluated according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria and PRISMA guidelines. Relative risk (RR) for mortality at 1 and 2 years and progression at 6 months and 1 year. The search produced 37 studies suitable for inclusion (41 117 unique patients). The meta-analysis revealed decreased mortality for GTR compared with STR at 1 year (RR, 0.62; 95%CI, 0.56–0.69; P < .001; number needed to treat [NNT], 9) and 2 years (RR, 0.84; 95% CI, 0.79–0.89; P < .001; NNT, 17). The 1-year risk for mortality for STR compared with biopsy was reduced significantly (RR, 0.85; 95%CI, 0.80–0.91; P < .001). The risk for mortality was similarly decreased for any resection compared with biopsy at 1 year (RR, 0.77; 95%CI, 0.71–0.84; P < .001; NNT, 21) and 2 years (RR, 0.94; 95%CI, 0.89–1.00; P = .04; NNT, 593). The likelihood of disease progression was decreased with GTR compared with STR at 6 months (RR, 0.72; 95%CI, 0.48–1.09; P = .12; NNT, 14) and 1 year (RR, 0.66; 95%CI, 0.43–0.99; P < .001; NNT, 26). The quality of the body of evidence by the GRADE criteria was moderate to low. This analysis represents the largest systematic review and only quantitative systematic review to date performed on this subject. Compared with STR, GTR substantially improves overall and progression-free survival, but the quality of the supporting evidence is moderate to low.
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