预防性颈中央区淋巴结清扫对cN0期甲状腺乳头状癌疗效的Meta分析

The effect of prophylactic central cervical lymph node dissection on papillary thyroid carcinoma in cNO stage:a Meta analysis

目的 探讨预防性颈中央区淋巴结清扫术(PCND)在cN0期甲状腺乳头状癌(PTC)患者手术治疗中的临床应用价值.方法 分别以"甲状腺乳头状癌、预防性颈中央区淋巴结清扫、复发、并发症"和"papillary thyroid carcinoma、prophylactic central neck dissection/prophylactic central cervical lymph node dissection、recurrence、complication"为中英文检索词,检索PubMed、EMbase、The Cochrane Library、CNKI、万方数据库、中国生物医学文献数据库,限定文献发表年限为2007—2017年,纳入比较单纯行甲状腺乳头状癌原发灶手术治疗(对照组)和同时加行预防性颈中央区淋巴结清扫(观察组)临床疗效的队列研究,由两名研究者独立筛选文献与提取数据,并进行质量评价.计数资料采用优势比(OR)及95%可信区间(CI)表示.采用I2进行异质性分析.结果 共纳入符合筛选标准的文献10篇,均为回顾性队列研究,共3383个研究对象,其中对照组1797例,观察组1586例.Meta分析结果显示:观察组与对照组局部复发率之间的差异无统计学意义(OR=0.97,95%CI 0.63~1.50,P=0.90).与对照组相比,观察组术后暂时性低钙血症(OR=2.20,95%CI 1.81~2.68,P<0.00001)、永久性低钙血症(OR=3.02,95%CI 1.97~4.61,P<0.00001)、暂时性喉返神经损伤(OR=1.58,95%CI 1.06~2.34,P=0.02)、永久性喉返神经损伤(OR=1.90,95%CI 1.10~3.58,P=0.05)的发生率均增高,且差异均有统计学意义.结论 对于cN0期PTC患者,在原发灶手术治疗的同时行PCND并不能降低肿瘤的局部复发率,但却能明显增加手术并发症风险;因此,不推荐临床常规实施该术式.

Objective To explore the clinical value of prophylactic central cervical lymph node dissection (PCND)as initial treatment for the patients with cN0 papillary thyroid carcinoma (PTA). Methods Literatures were researched using PubMed,EMbase,The Cochrane Library,CNKI,Wanfang database and the Chinese Biomedical Literature Database from 2007 to 2017 with the key words including "papillary thyroid carcinoma,prophylactic central neck dissection/prophylactic central cervical lymph node dissection,recurrence,complication".The cohort studies about comparison of clinical effects of thyroideetomy alone and thyroidectomy combined with prophylactic central cervical lymph node dissection were received and enrolled.Patients underwent papillary thyroid carcinoma using thyroidectomy alone and thyroidectomy combined with prophylactic central cervical lymph node dissection were respectively allocated into thyroidectomy group (control group)and thyroidectomy +prophylactic central neck dissection group (observation group).Two reviewers independently screened literatures,extracted data and assessed the risk of bias.Count data were described as odd ratio (OR)and 95% confidence interval (CI).The heterogeneity of the studies was analyzed using the I2 test.Results After literature screening,10 articles were selected, all of which were retrospective cohort study.A total of 3383 subjects were enrolled,including 1 797 cases in control group and 1 586 cases in observation group.Meta-analysis showed that:there was no significant difference in the local recurrence rate between the two groups(OR =0.97,95% CI O.63-1.50,P = 0.90).In observation group,the risks of temporary hypocalcemia (OR =2.20,95% CI 1.81-2.68,P <0.00001),permanent hypocalcemia (OR =3.02,95% CI 1.97-4.61,P <0.00001),temporary recurrent laryngeal nerve injury (OR =1.58,95%CI 1.06-2.34,P =0.02),permanent recurrent laryngeal nerve injury (OR =1.90,95% CI 1.10-3.58,P =0.05)were higher than those of control group,aiad the differences were statistically significant.Conclusions PCND for the patients with oN0 PTA does not reduce the local recurrence rate,but significantly increases the risks of the complications.