| Objectives The European Organisation for Research and Treatment of Cancer(EORTC)Lung Cancer Group conducted randomized controlled trials on patients with extensive stage small cell lung cancer(ES-SCLC)who responded to initial chemotherapy and found that patients treated with prophylactic cranial irradiation(PCI)could benefit from survival and reduce the risk of brain Metastasis.Then,a recent phase 3 clinical study in Japan found that ES-SCLC patients did not benefit from PCI.This conclusion prompted oncologists to rethink the role of prophylactic brain irradiation in patients with this ESSCLC.For this reason,we performed Meta analysis,and the main purpose of the study was to explore the effect of PCI on the survival of patients with extensive small cell lung cancer.Methods The related literatures on the treatment of extensive small cell lung cancer with PCI in the Cochrane Library,Pub Med,Embase,CNKI,Wanfang Data were comprehensively searched.Cochrane manual standard was used to evaluate the quality of included RCT studies.NOS scale was used to evaluate the quality of included cohort studies.Using Review Manager 5.3 and Stata 13.1 statistical softwares for Meta analysis.Between-study statistical heterogeneity was assessed using I2.A fixed-effects model was used unless I2 was>50%,indicating a substantial level of betweenstudy heterogeneity,in which case a random-effects model was used.We also conducted sensitivity analyses to evaluate the influence of individual studies in analyses with substantial heterogeneity of the overall effect estimate.The outcome indicators were overall survival time,6-month survival rate,1-year survival rate,2-year survival rate,1-year brain Metastasis rate and progression-free survival time.Significant clinical heterogeneity was treated by sensitivity analysis.Funnel chart,Begg's and Egger's were used to detect publication bias.Results A total of 12 articles were included in this study,including 7 randomized controlled studies and 5 retrospective studies.A total of 5826 patients with ES-SCLC,including 1133 patients in the PCI group and 4693 patients in the control group.1.Overall survival results: a total of 12 studies were included.Meta analysis showed that the overall survival time of the PCI group was better than that of the control group,which was statistically significant(HR=0.72,95% CI:0.60?0.88,P=0.001).The results of subgroup analysis showed that the overall survival time of the cohort study in the PCI group was significantly better than that in the control group(HR=0.63,95% CI:0.45?0.88,P=0.007),but there was no significant difference in the total survival time between the two groups in the RCT study(HR=0.80,95% CI:0.62?1.03,P=0.08);No matter whether the head imaging examination was performed before treatment,the PCI group was better than the control group,and had statistical significance.(HR=0.72,95% CI:0.55?0.94,P=0.01),(HR=0.68,95% CI:0.55?0.84,P=0.0004);There was no significant difference in overall survival time between the PCI group and the control group in Asia(HR=1.04,95% CI:0.66?1.64,P=0.87).In non-Asian regions,the PCI group was superior to the control group and had statistical difference(HR=0.65,95% CI:0.55?0.77,P<0.00001).2.The analysis results of 1-year brain Metastasis rate showed that the survival rate of the PCI group was lower than that of the control group(OR=0.30,95%CI: 0.15?0.60,P=0.0007).3.The analysis results of 6-month survival rate showed that no significant difference between the PCI group and the control group(OR=0.66,95%CI:0.39?1.12,P=0.13).4.The analysis results of 1-year survival rate showed that the survival rate of the PCI group was higher than that of the control group(OR=0.54,95% CI: 0.37?0.81,P=0.003).5.The analysis results of 2-year survival rate showed that the survival rate of the PCI group was higher than that of the control group(OR=0.55,95%CI: 0.40?0.77,P=0.0004)6.The analysis results of Progression-free survival showed that the survival rate of the PCI group was higher than that of the control group(HR =0.75,95%CI: 0.58?0.97,P= 0.03).Conclusions PCI can improve the 1-year brain Metastasis rate,progression-free survival,1-year survival rate and 2-year survival rate in patients with ES-SCLC.In terms of overall survival,patients with ES-SCLC can benefit from PCI,regardless of whether or not head imaging is performed before initial treatment.The Asian region may not benefit from this,and a large number of high-quality RCT studies are still needed to confirm this view.Figure12;Table2;Reference 120... |
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