偶发肾癌和症状肾癌临床诊疗特点比较的Meta分析

Comparison of clinical diagnosis and treatment between incidental renal cell carcinoma and symptomatic renal cell carcinoma:a meta-analysis

目的比较偶发肾癌和症状肾癌的临床诊疗特点,阐述早期检出肾癌的重要意义。方法检索Medline、PubMed、Cochrane Library、Web of Science、万方数据库、CNKI中文期刊数据库2000年1月1日至2016年12月31日国内外公开发表的所有关于偶发肾癌和症状肾癌临床研究的文献,按照纳入和排除标准对文献进行筛选,对纳入研究的文献进行数据提取和质量评价,采用Review Manager 5.3软件进行Meta分析。结果共纳入23篇文献,总计肾癌患者10 065例,其中偶发肾癌患者4 251例,症状肾癌患者5 814例。两组患者在肿瘤直径上平均差(MD)为-1.58(95%CI:-2.05^-1.11),在肿瘤病理分级(G1和G2)、保留肾单位手术例数、临床分期(T1和T2)、淋巴结转移、远处器官转移上比值比(OR)分别为3.01(95%CI:2.62~3.45)、3.47(95%CI:2.72~4.44)、3.95(95%CI:3.24~4.81)、0.20(95%CI:0.11~0.35)和0.24(95%CI:0.17~0.35),差异均有明显统计学意义(P<0.000 1);在手术年龄上MD为0.23(95%CI:-1.64~2.09),差异无统计学意义(P=0.81)。结论与症状肾癌相比,偶发肾癌具有肿瘤体积小、肿瘤病理分级低、临床分期早、淋巴结转移及远处器官转移少等特点,因此早期发现肾癌对提高患者生活质量及生存率十分重要。

Objective To compare the clinical characteristics,diagnosis and treatment between incidental renal cell carcinoma（IRCC）and symptomatic renal cell carcinoma（SRCC）,and expound the significance of early detection of RCC. Methods Relevant studies about IRCC and SRCC including Medline,PubMed,Embase,Cochrane Library,Web of Science,WanFang and CNKI were searched from January 1st,2000 to December 31 st,2016.A meta-analysis was conducted using Revman 5.3software. Results According to inclusion and exclusion criteria,a total of 23 studies met the inclusion criteria,including 10 065 patients,of whom 4 251 were IRCC group and the other5 814 were SRCC group.There was significant difference between IRCC and SRCC in tumor size（MD=-1.58,95% CI：-2.05--1.11）,pathological grading（G1and G2）（OR=3.01,95% CI：2.62-3.45）,nephron-sparing surgery（OR=3.47,95% CI：2.72-4.44）,clinical stage（T1and T2）（OR=3.95,95% CI：3.24-4.81）,lympho node metastasis（OR=0.20,95% CI：0.11-0.35）,distant organ metastasis（OR=0.24,95% CI：0.17-0.35）（P〈0.000 1）.However,there was no significant difference between IRCC and SRCC in age at operation（MD=0.23,95% CI：-1.64-2.09）（P=0.81）. Conclusions Compared with SRCC,IRCC has the advantages of smaller tumor size,lower pathological grading and clinical stage,less lympho node and distant organ metastasis,thus the early detection of RCC is very important to improve the patient＇s life quality and survival rate.