分化型甲状腺癌cN_0期Ⅵ区淋巴结清扫必要性的系统评价

Systematic review of the necessity of Level Ⅵ lymph node dissection in differentiated thyroid carcinoma with stage cN_0

目的系统评价分化型甲状腺癌(cN0期,临床淋巴结阴性)预防性颈清扫的必要性。方法计算机检索PubMed、ScienceDirect、Springer、Wiley、知网(CNKI)、维普(VlP)、万方数据库中关于甲状腺癌预防性颈清扫的随机对照试验,同时追索纳入文献的参考文献。检索时限均为从建库至2012年10月。由3名研究者对纳入的研究,参照GRADE系统推荐分级方法,进行质量评估并提取资料,进而行Meta分析。统计学分析采用RevMan 5.0软件和GRAED profiler 3.2.2软件。结果分化型甲状腺癌预防性Ⅵ区颈清扫术后发生暂时性低钙血症和暂时性喉返神经麻痹的风险增加(P<0.05或P<0.01),而发生永久性低钙血症和永久性声带麻痹的风险并没有增加(P>0.05)。结论分化型甲状腺癌cN0期是否常规行Ⅵ区淋巴结清扫,需根据实际情况如患者个体情况、肿瘤分期、危险分级及家庭社会等因素,谨慎选择。受纳入研究的质量和数量限制,上述结论尚需开展更多高质量随机对照实验加以验证。

Objective To systematically assess the safety and necessity of preventive neck cleaning in differentiated thyroid cancer.Methods RCTs in databases such as PubMed,ScienceDirect,SPRINGER,WILEY,CNKI （network）,VIP （VIP） and WANFANG regarding to thyroid cancer preventive neck cleaning from the date of establishment of the database to October 2012 were searched.At the same time,the references were screened.Three researchers went through strict evaluation and extraction against reference quality,and only the qualified references underwent Metaanalysis with Review Manager 5.0 and GRAED profiler 3.2.2.Results The risk of temporary recurrent laryngeal nerve injury and temporary hypocalcemia after preventive neck cleaning in differentiated thyroid cancer were increased （P ＜0.05 or P ＜ 0.01）,but the risk permanent recurrent laryngeal nerve injury and temporary hypocalcemia were not obvious increased （P ＞ 0.05）.Conclusion The role of central neck dissection （CND） remains controversial in differentiated thyroid cancer with stage cN 0.It is need to choose carefully according to the actual situation,such as including individual patients,tumor stage,grade of risk,social factors and so on.For the quality and quantity limitation of the included studies,this conclusion needs to be proved by performing more high quality RCTs.