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:与 SMLD 相比,NSMLD 的死亡风险更大[HR=1.23,95%CI(1.11,1.37),P<0.000 1]。但两组在无病生存期、局部复发率、远处转移率和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 组的不同手术方式进行亚组分析,对 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(L-SLD)方式,未见增加死亡风险。 结论 当前证据表明,与 SMLD 相比,采用 L-SLD 方式的 NSMLD 治疗早期 NSCLC 不会增加死亡风险,而采用 LN-S 方式的 NSMLD 可能会增加死亡风险。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。

Objectives 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 searched online to collect randomized controlled trials (RCTs) and non-randomized controlled studies (NRCTs) 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. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 16 studies (4 RCTs and 12 NRCTs) involving 4 718 patients were included. The results of meta-analysis showed that: Compared with the SMLD group, the NSMLD group had higher mortality (HR=1.23, 95%CI 1.11 to 1.37, P<0.000 1). There were no significant differences in disease-free survival, local recurrence rate, distant metastasis rate, and safety between two groups. In addition, the NSMLD group had shorter operation time, and lower drainage and blood loss. Subgroup analysis was performed according to operation methods. The results showed that: NSMLD group by lymph node sampling (LN-S) had higher mortality than SMLD group (HR=1.43, 95%CI 1.17 to 1.75,P=0.004), NSMLD group by lobe-specific lymph node dissection (L-SLD) did not have higher mortality. Conclusions Current evidence shows that: compared with SMLD, NSMLD by L-SLD do not have higher mortality in early stage NSCLC patients, while NSMLD by LN-S have higher mortality. Due to limited quality and quantity of the included studies, more high quality studies are required 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 controlled study

引用本文: 敬涛, 杨建宝, 冯海明, 马建兴, 拜争刚, 王成. 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. 中国循证医学杂志, 2018, 18(1): 43-51. doi: 10.7507/1672-2531.201704059 复制

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