局部消融治疗联合一线酪氨酸激酶抑制剂在表皮生长因子受体突变型寡转移非小细胞肺癌中的有效性：系统评价与荟萃分析。
完整摘要 · 中文译文
表皮生长因子受体（EGFR）突变是非小细胞肺癌（NSCLC）的重要驱动因素。尽管EGFR-酪氨酸激酶抑制剂（TKI）改善了结局，但耐药的发生限制了生存获益。局部消融治疗（LAT），尤其是放疗，可能进一步改善寡转移性NSCLC的结局，但其获益仍不确定。本荟萃分析评估了LAT联合TKI与单用TKI的疗效。我们系统检索了PubMed、Embase、Web of Science和Cochrane数据库，检索时间自建库至2025年5月，纳入比较EGFR突变寡转移性NSCLC患者接受TKI+LAT与单用TKI的研究。研究遵循PRISMA指南。结局指标包括总生存期（OS）、无进展生存期（PFS）和治疗相关不良事件。我们采用随机效应模型合并风险比（HR）和风险比（RR）及其95%置信区间（CI）。统计分析使用R软件（版本4.4.2）完成。共纳入9项研究、1077例患者，其中525例（48.7%）属于TKI+LAT组。平均随访时间为29.3个月。与单用TKI相比，接受TKI+LAT的患者OS显著更长（HR 0.50；95% CI 0.42-0.59；p < 0.001），PFS也显著更长（HR 0.44；95% CI 0.34-0.58；p < 0.001）。两组的毒性风险无统计学差异，提示LAT并未显著增加不良事件。在经选择的EGFR突变寡转移性NSCLC患者中，LAT联合TKI与生存改善相关，尤其是作为巩固治疗时，且安全性可接受。 y 分布/剖面。
完整摘要 · 英文原文
Epidermal Growth Factor Receptor (EGFR) mutations are a significant driver of NSCLC. Although EGFR-Tyrosine Kinase Inhibitors (TKIs) improve outcomes, the development of resistance limits the survival advantages. Local Ablative Therapy (LAT), particularly radiotherapy, may further enhance outcomes in oligometastatic NSCLC, but its benefit remains uncertain. This meta-analysis evaluates the efficacy of LAT with TKI vs. TKI alone. We systematically searched PubMed, Embase, Web of Science, and Cochrane from inception to May 2025 for studies comparing TKI + LAT versus TKI alone, in patients with EGFR-mutated oligometastatic NSCLC. PRISMA guidelines were followed. Outcomes included overall survival (OS), progression-free survival (PFS), and treatment related adverse effects. We pooled hazard ratios (HR) and risk ratios (RR) with a 95% confidence interval (CI) using a random effects model. Statistical Analysis was performed using R software (version 4.4.2). We included 9 studies with 1077 patients, of whom 525 (48.7%) belonged to the TKI + LAT group. Mean follow-up duration was 29.3 months. Patients receiving TKI + LAT had a significantly longer OS (HR 0.50; 95% CI 0.42-0.59; p < 0.001) and PFS (HR 0.44; 95% CI 0.34-0.58; p < 0.001) versus TKI alone. The toxicity risk was not statistically different between the arms, suggesting that LAT did not significantly increase adverse effects. LAT combined with TKI is associated with improved survival in selected patients with EGFR-mutated oligometastatic NSCLC, particularly when delivered as consolidation therapy, with an acceptable safety profile.