Objective: Craniopharyngioma recurrence risk studies comparing gross total resection (GTR) vs. subtotal resection (STR) with radiotherapy (XRT) provide inconclusive or contradictory results. This may be an effect of the small group sizes and diversity in the approaches used. Currently, the endoscopic endonasal approach (EEA) is preferred in craniopharyngioma management. Here, we aimed to perform a meta-analysis comparing recurrence risk after GTR vs. STR plus XRT in patients treated with the EEA regimen. Methods: We performed a systematic literature search of original English language papers on craniopharyngioma management published in the PubMed, Web of Science, and Scopus databases up to 18 October 2023. Eleven articles included data on recurrence rate after EEA: GTR vs. STR with XRT. We extracted the year of publication, number of patients, surgical approach, extent of resection, and follow-up duration. We used meta-analysis for the odds ratio (OR) in fixed and random effects models and Egger’s and Begg’s tests to assess heterogeneity and publication bias. Follow-up duration and time to recurrence were additionally included in Kaplan–Meier curves with log-rank test analysis. Results: We observed a lower recurrence rate in patients after GTR (10%) as compared to STR with XRT (30%), OR = 0.299,p< 0.001. To increase data reliability, we limited our analysis to studies with at least five patients in each subgroup and also observed lower recurrence in patients after GTR (12%) as compared to STR with XRT (27%), OR = 0.376,p= 0.011. Survival analysis confirmed significant differences in recurrence-free survival percentages between these groups (p= 0.008). Conclusions: To date, this is the largest meta-analysis evaluating the recurrence risk in patients undergoing EEA for craniopharyngioma resection, comparing outcomes between those treated with GTR and those treated with STR plus XRT. The results suggest that GTR significantly reduces recurrence risk.
目的：关于颅咽管瘤复发风险的现有研究，在比较肿瘤全切除（GTR）与次全切除（STR）联合放疗（XRT）的效果时，常得出不确定或相互矛盾的结论。这可能与样本量较小以及所采用的治疗方法多样性有关。目前，内镜经鼻入路（EEA）是颅咽管瘤治疗的首选术式。本研究旨在通过荟萃分析，比较接受EEA方案治疗的患者中，GTR与STR联合XRT后的复发风险。 方法：我们系统检索了截至2023年10月18日发表在PubMed、Web of Science和Scopus数据库中关于颅咽管瘤治疗的英文原创文献。共纳入11篇包含EEA术后复发率数据（比较GTR与STR联合XRT）的文章。提取信息包括发表年份、患者数量、手术方式、切除范围及随访时间。采用固定效应和随机效应模型计算比值比（OR）进行荟萃分析，并使用Egger's和Begg's检验评估异质性和发表偏倚。此外，将随访时间和复发时间纳入Kaplan-Meier曲线，并进行对数秩检验分析。 结果：我们发现，接受GTR的患者复发率（10%）低于接受STR联合XRT的患者（30%），OR = 0.299，p < 0.001。为提高数据可靠性，我们进一步将分析限制在每个亚组至少包含5名患者的研究中，结果仍显示GTR组复发率（12%）低于STR联合XRT组（27%），OR = 0.376，p = 0.011。生存分析证实两组间无复发生存率存在显著差异（p = 0.008）。 结论：这是迄今为止规模最大的荟萃分析，旨在评估接受EEA切除颅咽管瘤的患者中，比较GTR与STR联合XRT治疗后的复发风险。结果表明，GTR能显著降低复发风险。
肿瘤(癌症)患者之家