文献速递：手术切除程度、放疗、化疗对低级别胶质瘤病人预后影响的meta分析

背景：低级别胶质瘤的最佳治疗仍存在争议，且存在广泛的实践差异。这项基于证据的荟萃分析评估了低级别胶质瘤患者的切除程度，放疗和化疗与2年，5年和10年死亡率和无进展生存率之间的关系。

方法：进行了定量的系统评价。纳入标准包括成人新诊断的低级别胶质瘤（WHO I级和II级）（译者注：这是这篇文献的缺陷，如果全部是II级就好了，活着仅仅包括II级星形细胞瘤，少突胶质细胞瘤或混合性少突星形细胞瘤，就更好了）的对照试验。鉴定合格的研究，为每个研究终点分配证据水平，并根据系统评价和Meta分析指南的首选报告项目进行分析。计算了切除（全切，次全切除或活检）、放疗或化疗的患者在2、5和10年时死亡和进展的相对风险。

结果：与次全切除相比，全切病人在所有时间段内总体死亡率和进站率均显著降低。早期放疗与死亡率降低无关，然而，与延迟或不放疗的患者相比，早期放疗患者5年无进展生存期更好。在高质量文献中，化疗后5年和10年死亡率降低。与未接受化疗的患者相比，化疗患者的5年和10年无进展生存期更好。在接受化疗的IDH1突变（R132H）患者中，2年和5年无进展生存期优于IDH1野生型胶质瘤患者。

结论：这篇综述的结果是第一个量化的低级别胶质瘤患者手术、放疗和化疗与预后相关的文献，可用于指导循证治疗和未来临床试验。

下面是文章的图片：

下面是文章的摘要：

Background. Optimum management of low-grade gliomas remains controversial, and widespread practice vari- ation exists. This evidence-based meta-analysis evaluates the association of extent of resection, radiation, and chemotherapy with mortality and progression-free survival at 2, 5, and 10 years in patients with low-grade glioma. Methods. A quantitative systematic review was performed. Inclusion criteria included controlled trials of newly diagnosed low-grade (World Health Organization Grades I and II) gliomas in adults. Eligible studies were identified, assigned a level of evidence for every endpoint considered, and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The relative risk of mortality and of progression at 2, 5, and 10 years was calculated for patients undergoing resection (gross total, subtotal, or biopsy), radiation, or chemotherapy. Results. Gross total resection was significantly associated with decreased mortality and likelihood of progres- sion at all time points compared to subtotal resection. Early radiation was not associated with decreased mor- tality; however, progression-free survival was better at 5 years compared to patients receiving delayed or no radiation. Chemotherapy was associated with decreased mortality at 5 and 10 years in the high-quality literature. Progression-free survival was better at 5 and 10 years compared to patients who did not receive chemotherapy. In patients with isocitrate dehydrogenase 1 gene (IDH1) R132H mutations receiving chemotherapy, progression-free survival was better at 2 and 5 years than in patients with IDH1 wild-type gliomas. Conclusions. Results from this review, the first to quantify differences in outcome associated with surgery, radia- tion, and chemotherapy in patients with low-grade gliomas, can be used to inform evidence-based management and future clinical trials.

参考文献：

1. Brown TJ, Bota DA, Van Den Bent MJ, et al. Management of low-grade glioma: A systematic review and meta-Analysis. In: Neuro-Oncology Practice. Vol 6. Oxford University Press; 2019:249-258. doi:10.1093/nop/npy034

网页连接：

Pubmed：http://www.ncbi.nlm.nih.gov/pubmed/31386075

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC6660818