胸腺上皮肿瘤患者的手术、放疗和全身治疗：系统综述

SCI 3 December 2022

Surgical, Radiation, and Systemic Treatments of Patients with Thymic Epithelial Tumours: A Systematic Review

(IF: JTO., 20.121)

Falkson CB, Vella ET, Ellis PM, Maziak DE, Ung YC, Yu E, Surgical, Radiation, and Systemic Treatments of Patients with Thymic Epithelial Tumours: A Systematic Review, Journal of Thoracic Oncology (2022).

Correspondence: Dr. Conrad Falkson c/o Dr. Emily Vella Program in Evidence-Based Care, McMaster University, Juravinski Hospital G Wing, 2nd Floor, 711 Concession Street, Hamilton, ON L8V 1C3 Phone: 905-527-4322 x42822, Fax: 905-526-6775, Email: vellaem@mcmaster.ca ccopgi@mcmaster.ca

Introduction 介绍  

Thymic epithelial tumours are rare and are classified as thymoma, thymic carcinoma, and thymic neuroendocrine tumours. The objective of this systematic review was to examine the treatment options for patients with thymic epithelial tumours. 

胸腺上皮肿瘤很罕见，分为胸腺瘤、胸腺癌和胸腺神经内分泌肿瘤。本系统综述的目的是检查胸腺上皮肿瘤患者的治疗选择。

Methods 方法

 This systematic review was developed by Ontario Health (Cancer Care Ontario)’s Program in Evidence-Based Care and by the Lung Cancer Disease Site Group. MEDLINE, EMBASE, and the Cochrane Library were searched for studies comparing surgical, radiotherapy, or systemic treatments against any combination of these treatments, in patients with thymic epithelial tumours. Meta-analyses were conducted with clinically homogenous studies.

这项系统综述由安大略省卫生部（安大略省癌症护理）循证护理计划和肺癌疾病现场小组制定。检索了MEDLINE、EMBASE和Cochrane图书馆，比较胸腺上皮肿瘤患者的手术、放疗或全身治疗与这些治疗的任何组合。荟萃分析采用临床同质研究进行。

Results 结果

One hundred and six studies were included, mainly from observational studies. There was an overall survival benefit with postoperative radiotherapy for patients with thymic carcinoma (hazard ratio = 0.65, 95% confidence interval: 0.47-0.89) and for patients with thymoma (hazard ratio = 0.70, 95% confidence interval: 0.59-0.82), especially for those with a high risk for mortality. Patients with thymic carcinoma or thymoma demonstrated a response to chemotherapy. Selection bias impacted the results for studies that examined neoadjuvant chemotherapy or minimally invasive surgical techniques. Furthermore, the overall survival benefit seen for adjuvant chemotherapy may have been confounded by the administration of postoperative radiotherapy. 

其中囊括了106项研究，主要来自观察性研究。胸腺癌患者（风险比=0.65，95%置信区间：0.47-0.89）和胸腺瘤患者（风险比=0.70，95%置信区间：0.59-0.82）术后放疗具有总体生存获益，特别是对于那些死亡风险高的人。胸腺癌或胸腺瘤患者对化疗有响应。选择偏差影响了检查新辅助化疗或微创手术技术的研究结果。此外，辅助化疗的总体生存效益可能与术后放疗的实施相混淆。

Conclusion 结论

For patients with thymoma or thymic carcinoma, the literature is low quality and subject to bias. There were overall survival benefits with postoperative radiotherapy. The results of this systematic review were used to inform treatment recommendations in a clinical practice guideline. Future large-scale prospective studies that control for confounders are needed.

对于胸腺瘤或胸腺癌患者，现有的文献质量较低且存在偏移。术后放疗能获得总体生存获益。该系统综述的结果被用于为临床实践指南中的治疗建议提供信息。未来需要进行控制混杂因素的大规模前瞻性研究。

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