摘要
目的探讨系统性淋巴结清扫(LND)与采样及系统性采样淋巴结清扫(LNS)治疗肺癌的临床疗效和安全性。方法以"非小细胞肺癌、系统性淋巴结清扫、采样及系统性采样淋巴结清扫"等为检索词,分别检索Cochrane图书馆(2011年第2期)、PubMed及EMBase,同时检索中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊数据库(VIP)和万方数据库。检索时间截至2011年7月。收集LND及LNS治疗肺癌的随机对照试验(RCT)、半RCT及非RCT,采用Cochrane系统评价的方法,提取数据并由2名评价者独立评价并交叉核对纳入研究的质量,对同质研究采用RevMan5.0软件进行Meta分析。评价指标包括5年生存率、原位复发率、远处转移率、并发症发生率等。结果最终符合入选标准的文献共7篇,包括4个RCT和2个非RCT,共1 983例患者。(1)LND可以提高患者术后5年生存率〔RR=0.63,95%CI(0.47,0.83)〕;(2)LND与LNS在原位复发率方面的差异无统计学意义〔RR=1.10,95%CI(0.77,1.58)〕;(3)LND与LNS在远处转移方面的差异无统计学意义〔RR=1.19,95%CI(0.95,1.49)〕;(4)LND与LNS在房性心律失常、术后漏气、术后肺炎、术后乳糜胸并发症方面差异无统计学意义,但LNS可增加术后神经损伤的发生率〔RR=0.25,95%CI(0.06,0.98)〕。结论对于肺癌患者,LND能提高患者的5年生存率,但将会增加神经损伤的发生率。
Objective To evaluate the clinical efficacy and safety of systematic node dissection for lung canc- er. Methods We searched the electronic bibliographic databases, including the Cochrane Library, PubMed, EMBase, CBM, CNKI, VIP database and Wanfang database to assemble the randomized controlled trials （RCTs） , half RCTs, non - RCTs of systematic node dissection and node dissection of sampling or systematic sampling for lung cancer. The deadline of the retrieval time was July 2011. Data were extracted and evaluated by two reviewers independently with a designed extraction form. The Rev- Man 5.0 software was used for meta - analysis on homogeneous studies. Results Four RCTs and two non - RCTs involving 1 983 patients were included. The results of meta - analyses showed ： （ 1 ） the 5 - year survival rate in systematic node dissection group was higher than that in the other group [ RR = O. 63, 95 % CI （0. 47, O. 83 ） ~ ; （2） there was no significant difference in re- currence rate between two groups [ RR = 1.10, 95% CI （0. 77, 1.58） ~ ; （3） there was no significant difference in the inci- dence of distant metastasis between two groups [ RR = 1.19, 95% CI （0.95, 1.49） ~ ; （4） there was no significant difference in the incidence of postoperative complications between two groups, including atrial arrhyttmia, postoperative leak, postoperative pneumonia, postoperative chylothorax, however, the incidence of postoperative neurological injury in systematic node dissection group was higher [ RR = 0. 25, 95% CI （0. 06, 0.98） 3 . Conclusion Evidences show that systematic node dissection could improve the 5 -year survival rate of patients with lung cancer, but will bring higher incidence of postoperative neurological inju- ry.
出处
《中国全科医学》
CAS
CSCD
北大核心
2012年第18期2067-2070,共4页
Chinese General Practice
关键词
肺肿瘤
采样及系统性采样淋巴结清扫
系统性淋巴结清扫
随机对照试验
META分析
Lung neoplasms
Node dissection of sampling or systematic sampling
Systematic node dissection
Ran- domized controlled trial
Meta- analysis
