淋巴血管侵犯对根治性膀胱切除术后患者相关临床预后意义的Meta分析

The clinical prognostic value of lymphovascular invasion in bladder cancer following radical cystectomy： a systematic review and Meta-analysis

目的系统性评价淋巴血管侵犯在预测根治性膀胱切除术后患者临床预后方面的作用。方法通过计算机检索PubMed、EMBASE、Web of Science、Cochrane图书馆、中国知网、万方、维普数据库中有关淋巴血管侵犯与根治性膀胱切除术后患者的生存预后分析研究，检索时限设置为建库开始至2017年5月，检索语种为英文及中文。采用NOS工具对纳入的文献进行方法质量学评价，并采用Rev Man 5.3与Stata 12.0软件对淋巴血管侵犯与根治性膀胱切除术后患者临床预后方面进行统计分析。结果最终共纳入18篇相关临床队列研究，发表时间2008—2017年。相关膀胱癌患者共12 354例，其中有淋巴血管侵犯者4 272例，占34.6%。Meta分析结果显示，淋巴血管阳性的根治性膀胱切除术后患者在总体生存率（HR＝1.26，95%CI 1.16～1.38，P〈0.001）、无复发生存率（HR＝1.27，95%CI 1.06～1.52 ，P〈0.001）、肿瘤特异性生存率（HR＝1.30，95%CI 1.18～1.42，P〈0.001）3个方面均低于淋巴血管阴性的患者。Egger′s发表偏倚分析结果显示，淋巴血管侵犯在总体生存率（P＝0.636）、无复发生存率（P＝0.077）、肿瘤特异性生存率（P＝0.342）方面均无显著的发表偏倚。结论淋巴血管侵犯与根治性膀胱切除术后患者的临床预后显著相关，可作为评价此类患者术后预后的独立影响因子，但相关结论仍需多中心随机对照研究进一步证实。

To systematically evaluate the expression of lymphovascular invasion （LVI） in predicting the clinical prognosis of patients after radical cystectomy.MethodsThe relevant search strategy, including and excluding criteria for the relevant literature were developed by two independent researchers. The study of tumor prognosis in the patients with LVI following radical cystectomy cancer were searched by computerized PubMed, EMBASE, Web of Science, Cochrane library, China National Knowledge Infrastructure （CNKI） , Wanfang and VIP citation database. The search period was setted from the beginning of establishment of library until May 2017, and the search language was English and Chinese. The methodological quality of the included studies was assessed by the NOS. Besides, the relationship between LVI and the clinical outcome in patients following radical cystectomy was calculated by RevMan 5.3 and Stata 12.0 software.ResultsA total of 18 related clinical studies were included, published from 2008 to 2017. There were 12 354 patients with bladder cancer, of which 4 272 cases of LVI, with a proportion rate 34.6% .The results showed that the patients with LVI in pathological sections had a lower overall survival rate （HR=1.26, 95%CI 1.16-1.38 , P〈0.001）, recurrence-free survival （HR=1.27, 95%CI 1.06-1.52, P〈0.001）, cancer-specific survival rate （HR=1.30, 95%CI 1.18-1.42 , P〈0.001） . Egger′s publication bias analysis showed no significant publication bias in terms of overall survival（P=0.636）, recurrence-free survival （P=0.077）, and cancer-specific survival （P=0.342）.ConclusionsLVI had a significant poor outcome in patients with radical resection of bladder cancer. It can be used as an independent risk factor to evaluate the postoperative prognosis of those patients, but more randomized controlled studies are still needed to make a further conformity in our completion.