新辅助疗法是否有助于增加食道癌的道性泄漏风险? 一个网络元分析
Da Zhou1, Donglai Chen2, Peidong Song1
1Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China.
Journal of evidence-based medicine
|August 20, 2024
概括
新辅助疗法在食道切除术后不会显著增加静脉漏 (AL). 中等剂量的辐射与AL风险升高无关,这使得临床医生对新辅助化学辐射 (nCRT) 的使用感到放心.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 关于新辅助疗法对食道切除术后的道泄漏 (AL) 的影响,存在相互矛盾的数据.
- 了解这种关系对于优化治疗策略至关重要.
研究的目的:
- 进行网络元分析,评估新辅助疗法在食道切除术后对AL的影响.
- 为了比较新辅助化疗 (nCRT),化疗 (nCT),放射治疗 (nR),免疫化疗 (nICT) 和单独手术 (SA).
主要方法:
- 贝叶斯网络对62项研究 (12,746名患者) 的元分析,包括RCT和回顾性研究.
- 五种治疗方式的比较:nCRT,nCT,nR,nICT和SA.
- 根据辐射剂量,检查的淋巴结,重建路线,解位和手术方法进行子组分析.
主要成果:
- 在RCT和RS中,在五种治疗方式之间没有观察到AL率的显著差异.
- 亚组分析表明AL没有显著差异,除了nCRT与nCT的辐射剂量≥41.4 Gy (RR0.21,95%CI0.05-0.73).
结论:
- 新辅助疗法在食道切除术后不会显著增加AL的发生率.
- 中等剂量的辐射与AL风险升高无关.
- 临床医生可以更自信地开出nCRT.
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