中国循证医学杂志

中国循证医学杂志

早期非小细胞肺癌不同淋巴结清扫方式疗效及安全性的 Meta 分析

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目的 系统评价非系统性淋巴结清扫(NSMLD)与系统性淋巴结清扫(SMLD)比较治疗早期非小细胞肺癌(NSCLC)的临床疗效和安全性。 方法 计算机检索 PubMed、EMbase、Web of Science 和 The Cochrane library 数据库,搜集 NSMLD 与 SMLD 比较治疗 NSCLC 的随机对照试验(RCT)和非随机对照研究(NRCT),检索时限均为建库至 2016 年 10 月。由 2 名评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。 结果 共纳入 16 个研究,包括 4 个 RCT 和 12 个 NRCT,共 4 718 例患者。Meta 分析结果显示:NSMLD 的死亡风险更大[HR=1.23,95%CI(1.11,1.37),P<0.000 1],其差异有统计学意义。但两组在无病生存期、局部复发率、远处转移率及安全性方面差异无统计学意义。此外,NSMLD 组手术时间更短,引流量和失血量更少。按照 NSMLD 组的不同手术方式及纳入研究设计进行亚组分析,NRCT 的 Meta 分析结果显示:与 SMLD 相比,NSMLD 组采用淋巴结采样(LN-S)的手术方式会增加死亡风险[HR=1.43,95%CI(1.17,1.75),P=0.004];而采用肺叶特异性淋巴结清扫方式(L-SLD),死亡风险在 SMLD 组与 NSMLD 组比较差异无统计学意义。 结论 当前证据表明,与 SMLD 相比,NSMLD 治疗早期 NSCLC 可增加死亡风险,而 L-SLD 的死亡风险与 SMLD 相当。NSMLD 的局部复发率、远处转移率与 SMLD 相比并无差异,且手术时间更短,引流量和失血量更少。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

To systematically review the efficacy and safety of non-systemic lymph dissection (NSMLD) vs. systemic lymph dissection (SMLD) for early stage non-small cell lung cancer (NSCLC). Methods PubMed, EMbase, Web of Science and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCT) and non-randomized control study (NRCT) of NSMLD vs. SMLD for NSCLC patients from inception to October, 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 16 studies (4 RCTs and 12 NRCT) involving 4 718 patients were included. The results of meta-analysis showed that: the SMLD group increased the overall survival (OS) compared with NSMLD group (HR=1.23, 95%CI 1.11 to 1.37, P<0.000 1). There were no significant difference in disease-free survival, the local recurrence rate, distant metastasis rate and safety between two groups. NSMLD could shorten the operation time, reduce drainage and blood loss. Subgroup analysis was performed according to operation methods and study designs. The results showed that: in lymph node sampling (LN-S) increased the risk of death in NSMLD than SMLD (HR=1.43, 95%CI 1.17 to 1.75,P=0.004); while no significant difference of risk of death was found for lobe-specific lymph node dissection (L-SLD) between both groups. Conclusion Current evidence shows that compared with SMLD, NSMLD can increase the risk of death of early stage NSCLC patients, but the risk of death by L-SLD is similar to SMLD group. There are no differences in local recurrence rate and distant metastasis rate between SMLD and NSMLD groups, while NSMLD can shorten the operation time, reduce drainage and blood loss. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.

关键词: 非小细胞肺癌; 系统性纵隔淋巴结清扫; 淋巴结采样; 肺叶特异性淋巴结清扫; Meta 分析; 系统评价; 随机对照试验; 非随机对照研究

Key words: Non-small cell lung cancer; Systemic mediastinal lymph node dissection; Lymph node-sampling; Lobe-specific lymph node dissection; Meta-analysis; Systematic review; Randomized controlled trial; Non-randomized control study

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