对混合性毛玻璃样结节和单纯性毛玻璃样结节的临床Ⅰ期非小细胞肺癌患者进行淋巴结转移率比较的Meta分析

Metastatic rate of lymph nodes in clinical stageⅠnon-small-cell lung cancer patients with mixed ground-glass opacity versus pure ground-glass opacity:Meta-analysis

目的:比较单纯性毛玻璃样结节(pure ground-glass opacity,Pure-GGO)和混合性毛玻璃样结节(mixed ground-glassopacity,Mixed-GGO)的临床Ⅰ期非小细胞肺癌患者肺门淋巴结与纵隔淋巴结的转移率,用以指导清扫毛玻璃样结节(ground-glass opacity,GGO)患者淋巴结的手术方式。方法:使用主要数据库(Science Direct、Pub Med、Springer Link和Wiley Online Li-brary),收集临床Ⅰ期非小细胞肺癌Pure-GGO和Mixed-GGO患者的相关病例对照研究,对已出版的文献进行系统综述;使用STATA 12.0从已出版的文献中提取数据进行Meta分析。Meta分析的结果用优势比(OR)及其相应的95%置信区间(CI)表示。结果:从3篇病例对照研究包括总计736例患者中提取数据。进行比较后发现,两组患者在总淋巴结转移率上没有显著性差异(OR=3.66,95%CI:0.68~19.58,P=0.13),在肺门淋巴结转移率上也没有显著性差异(OR=4.22,95%Cl:0.77~23.19,P=0.10),但是有研究OR高达20.18(95%CI:0.94~432.12)。两组患者的纵隔淋巴结转移率没有显著差异(OR=1.10,95%CI:0.19~6.32,P=0.92)。结论:虽然结果显示两组患者在肺门淋巴结和纵隔淋巴结的转移率方面没有统计学差异,但是仍不能排除Mixed-GGO患者的肺门淋巴结转移情况。

Objective：This systematic review and Meta-analysis aimed to investigate the metastatic rate of hilar lymph node andmediastinal lymph node in clinical stage Ⅰ non-small-cell lung cancer patients with either pure ground-glass opacity（Pure-GGO）ormixed ground-glass opacity（Mixed-GGO）,therefore to indicate how to dissect lymph nodes in patients with GGO. Methods：Asystematic search of the published literature was conducted using the main databases（Science Direct,Pub Med,Springer Link andWiley Online Library）to collect relevant case-control studies that compared Pure-GGOs and Mixed-GGOs in clinical stage I non-small-cell lung cancer patients. Meta-analysis was performed extracting data from the published literature using STATA 12.0. The results ofthe Meta-analysis were expressed as an odds ratio（OR）and their corresponding 95% confidence interval（CI）. Results：We extracteddata from three case-control studies,with a total of 736 patients. There was no significant difference（OR=3.66,95% CI：0.68-19.58,P=0.13）in the rates of metastases in all lymph nodes in patients with either Pure-GGO or Mixed-GGO. In addition,there were nosignificant differences（OR=4.22,95% CI：0.77-23.19,P=0.10）in the rates of metastases in hilar lymph nodes in patients with eitherPure-GGO or Mixed-GGO,but one study showed an OR of 20.18（95% CI：0.94-432.12）. There was no significant difference in ratesof metastases of mediastinal lymph nodes in patients with either Pure-GGO or Mixed-GGO（OR=1.10;95% CI：0.19-6.32,P=0.92）.Conclusion：The results indicated no statistically significant difference in metastatic rates of hilar lymph nodes and mediastinal lymphnodes in patients with either Pure-GGO or Mixed-GGO. However,as thoracic surgeon,we must be particularly cautious aboutmetastasis in hilar lymph nodes in patients with Mixed-GGO.