摘要
目的评价系统性腹膜后淋巴结切除(systematic lymphadenectomy,SL)与非系统性腹膜后淋巴结切除(unsystematic lymphadenectomy,USL)治疗上皮性卵巢癌(EOC)的有效性。方法计算机检索PubMed、EMbase、Cochrane Library、循证医学数据库(Evidence-Based Medicine Reviews,EBMR)、中国生物医学文献数据库、中国期刊全文数据库和中文科技期刊全文数据库等,检索时限为1995年1月1日至2010年12月31日,纳入SL与USL比较治疗上皮性卵巢癌的随机对照试验(RCT)或观察性研究。采用Cochrane系统评价方法对纳入研究进行资料提取和方法学质量评价后,用RevMan 5.0软件进行Meta分析。结果共纳入13个研究,22 796例患者,其中SL组5?420例,USL组17?376例。13个纳入研究中,2个为RCT,11个为观察性研究(其中2个数据来自美国国立癌症中心的SEER数据库)。2个RCT的结果显示,与USL相比:①SL不能改善早期(FIGOⅠ～Ⅱ)上皮性卵巢癌患者的5年无进展生存率(5-PFS)[OR=0.70,95%CI(0.40,1.22),P=0.21],但能改善晚期(FIGOⅢ～Ⅳ)上皮性卵巢癌患者的5-PFS[OR=0.62,95%CI(0.40,0.96),P=0.03];②SL不能改善早期[OR=0.84,95%C(I0.44,1.58),P=0.58]及晚期[OR=0.93,95%C(I0.64,1.37),P=0.73]上皮性卵巢癌患者的5年总生存率(5-OS);③SL也不能改善达到理想减瘤的早期[OR=0.84,95%CI(0.44,1.58),P=0.58]及晚期[OR=0.93,95%CI(0.64,1.37),P=0.73]上皮性卵巢癌患者的5-OS。观察性研究的合并分析结果显示,与USL相比:①SL不能改善早期[OR=0.38,95%CI(0.08,1.74),P=0.21]及晚期[OR=2.88,95%CI(0.95,8.72),P=0.06]上皮性卵巢癌患者的5-PFS;②不论是否除外SEER的影响,SL均能改善早期[OR=0.54,95%C(I0.46,0.63),P<0.00001;OR=0.59,95%C(I0.38,0.92),P<0.02]及晚期[OR=0.47,95%CI(0.43,0.52),P<0.000?01;OR=0.57,95%CI(0.42,0.77),P=0.0002]上皮性卵巢癌患者的5-OS;③SL不能改善达到理想减瘤的早期患者的5-OS[OR=0.32,95%CI(0.02,6.19),P=0.45],但能改善达到理想减瘤的晚期上皮性卵巢癌患者的5-OS[OR=0.53,95%CI(0.32,0.88),P=0.01]。结论 SL有可能改善上皮性卵巢癌的5-PFS及5-OS。但由于缺乏足够的RCT,SL对上皮性卵巢癌5-PFS及5-OS的影响仍不确定,需要开展更多RCT进一步明确。
Objective To evaluate the role of systematic lymphadenectomy（SL） vs.unsystematic lymphadenectomy（USL） for improving overall survival（OS） in epithelial ovarian cancer（EOC）.Methods The databases such as PubMed,EMbase,The Cochrane Library,Evidence-Based Medicine Reviews（EBMR）,CBM,CNKI and VIP were searched between January 1,1995 and December 31,2010,the randomized controlled trials（RCTs） and observational studies on SL vs.USL in treating EOC were included.Based on Cochrane handbook,the data were extracted,the methodological quality was assessed,and then meta-analyses were conducted by using RevMan 5.0 software.Results The total 13 studies involving 22？796 patients were included,including 5？420 patients in the SL group,and the other 17？376 patients in the USL group.Two of the 13 studies were RCTs,and the other 11 were observational studies（including 2 studies retrieved from SEER data）.The analyses on 2 RCTs showed that compared with USL,a） SL could not improve 5-PFS（OR=0.70,95%CI 0.40 to 1.22,P=0.21） in early-stage EOC（FIGO I to II）,but it did improve 5-PFS（OR=0.62,95%CI 0.40 to 0.96,P=0.03） in advanced-stage EOC（FIGO III to IV）;b） SL could not improve 5-OS in both early-stage EOC（OR=0.84;95%CI 0.44 to1.58,P=0.58） and advanced-stage EOC（OR=0.93,95%CI 0.64 to 1.37,P=0.73）;and c） SL could not improve 5-OS in both early-stage（OR=0.84,95%CI 0.44 to 1.58,P=0.58） and advanced-stage（OR=0.93,95%CI 0.64 to 1.37,P=0.73） of EOC patients who had optimal tumor dubulking surgery.The analyses on observational studies showed that compared with USL,a） SL could not improve 5-PFS in both early-stage EOC（OR=0.38,95%CI 0.08 to 1.74,P=0.21） and advanced-stage（OR=2.88,95%CI 0.95 to 8.72,P=0.06） EOC;b） Whether SEER impacts were excluded or not,SL did improve 5-OS in both early-stage EOC（OR=0.54,95%CI 0.46 to 0.63,P0.000？01） and advanced-stage（OR=0.47,95%CI 0.43 to 0.52,P0.000？01） EOC;and c） For EOC patients who had optimal tumor dubulking surgery,SL could not improve 5-OS in early-stage（OR=0.32,95% CI 0.02 to 6.19,P=0.45）,but it did improve 5-OS in advanced-stage（OR=0.53,95%CI 0.32 to 0.88,P=0.01）.Conclusion These findings suggest that maybe SL can improve 5-PFS and 5-OS in EOC.However,the efficacy of SL on 5-PFS and 5-OS is still undetermined,so more relevant studies are required for further investigating the role of SL in EOC.
出处
《中国循证医学杂志》
CSCD
2012年第2期224-230,共7页
Chinese Journal of Evidence-based Medicine
基金
广西卫生厅临床科研基金资助(编号:Z2010153)
