原发性玻璃体视网膜淋巴瘤患者各种治疗方法的比较:系统回顾与荟萃分析。

IF 4.9 2区 医学 Q1 OPHTHALMOLOGY Clinical and Experimental Ophthalmology Pub Date : 2024-09-24 DOI:10.1111/ceo.14443
Michael Ostrovsky, Tal Corina Sela, Zohar Habot-Wilner
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引用次数: 0

摘要

背景:本系统综述和荟萃分析研究了不同治疗方式对原发性玻璃体视网膜淋巴瘤患者中枢神经系统淋巴瘤进展、眼部疾病复发、全身淋巴瘤发展和总生存期风险的影响:方法:检索了 PubMed、EMBASE、Scopus 和 Cochrane Library 中从开始到 2024 年 4 月 21 日的临床试验。纳入了队列、横断面和病例系列研究。采用 NIH 质量评估工具对方法学质量进行评估。研究之间的异质性采用卡方检验和 I2 统计量进行评估。采用固定效应模型将结果汇总为几率比(OR)。采用漏斗图评估发表偏倚风险:结果:共纳入 28 项研究,476 名参与者。眼部治疗包括玻璃体内注射甲氨蝶呤和/或利妥昔单抗以及眼部放疗。全身治疗包括静脉注射和/或鞘内化疗、全脑放疗和自体干细胞移植。与全身治疗或联合治疗相比,单纯眼部治疗可显著降低中枢神经系统淋巴瘤的发病风险(OR = 0.54,p = 0.02),但在发展为全身性疾病的风险(OR = 0.38,p = 0.30)或总生存率方面没有显著差异。与单独接受系统治疗相比,接受眼部治疗或联合治疗的患者眼部复发风险明显降低(OR = 0.26,p = 0.001)。一项亚组分析比较了眼部单独治疗和联合治疗,发现在中枢神经系统或全身淋巴瘤进展风险、眼部疾病复发和总生存率方面没有显著差异:原发性玻璃体视网膜淋巴瘤患者在眼部治疗的基础上加用全身治疗,未发现任何益处。
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Comparison of various treatment modalities in patients with primary vitreoretinal lymphoma: A systematic review and meta-analysis.

Background: This systematic review and meta-analysis investigated different treatment modalities' effect on the risk of central nervous system lymphoma progression, ocular disease relapse, systemic lymphoma development and overall survival in primary vitreoretinal lymphoma patients.

Methods: PubMed, EMBASE, Scopus and the Cochrane Library of clinical trials were searched from inception to April 21, 2024. Cohort, cross-sectional and case series studies were included. Methodological quality was assessed using the NIH quality assessment tools. Heterogeneity between studies was assessed using Chi square test and I2 statistic. Outcomes were pooled as odds ratios (OR) using fixed-effects models. Risk of publication bias was assessed using a funnel plot.

Results: Included were 28 studies with 476 participants. Ocular treatments included intravitreal methotrexate and/or rituximab injections and ocular radiotherapy. Systemic treatments included intravenous and/or intrathecal chemotherapy, whole-brain radiotherapy and autologous stem cell transplantation. Ocular treatment alone, as compared to systemic or combined treatment, resulted in significantly lower risk of central nervous system lymphoma development (OR = 0.54, p = 0.02) and in no significant difference in the risk for progression to systemic disease (OR = 0.38, p = 0.30) or in overall survival. Significantly lower risk of ocular relapse was found in patients receiving ocular or combined therapy as compared to systemic therapy alone (OR = 0.26, p = 0.001). A subgroup analysis, comparing ocular treatment alone and combined treatment, found no significant difference regarding the risk of central nervous system or systemic lymphoma progression, ocular disease relapse and overall survival.

Conclusions: No benefit was observed for the addition of systemic therapy to ocular treatment in patients with primary vitreoretinal lymphoma.

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来源期刊
CiteScore
7.60
自引率
12.50%
发文量
150
审稿时长
4-8 weeks
期刊介绍: Clinical & Experimental Ophthalmology is the official journal of The Royal Australian and New Zealand College of Ophthalmologists. The journal publishes peer-reviewed original research and reviews dealing with all aspects of clinical practice and research which are international in scope and application. CEO recognises the importance of collaborative research and welcomes papers that have a direct influence on ophthalmic practice but are not unique to ophthalmology.
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