胸腔冲洗液细胞学检查对非小细胞肺癌患者术后预后评估的Meta分析

Prognosis of pneumonectomy in patients with non-small cell lung cancer by pleural lavage cytology:a meta-analysis

目的系统评价肺癌根治术术中胸膜腔冲洗细胞学检查(PLC)阳性和阴性分别对应的非小细胞肺癌(NSCLC)患者术后5年死亡率、复发率及转移的情况。方法计算机检索PubMed、EmBase、Cochrane Library、CNKI、VIP与万方数据库。按照文献纳入和排除标准,选择术中开胸后立即行PLC对NSCLC患者肺切除预后关系的队列研究,检索时限均为建库至2017年11月。应用RevMan 5.3软件进行数据处理,计算其合并危险比值(Risk ratio,RR)及95%的可信区间(confidence interval,CI)。结果共纳入11个队列研究,共包括11 856例NSCLC患者,其中PLC阳性组533例,PLC阴性组11 323例。Meta分析结果显示,NSCLC患者术中PLC阳性PLC阴性相比,术中PLC阳性的患者不仅与不良生存率有关,而且与复发和转移也相关,尤其是胸膜转移。两组在肺切除术后5年各期总死亡率(RR=1.99,95%CI=1.84~2.14,P<0.01),Ⅰ期(NSCLC临床分期)术后5年死亡率(RR=2.10,95%CI=1.85~2.39,P<0.01),总复发率(RR=2.54,95%CI=2.21~2.92,P<0.01),胸膜转移(RR=8.17,95%CI=6.02~11.10,P<0.01)及远处转移(RR=2.65,95%CI=2.12~3.31,P<0.01)差异均具有统计学意义。结论 PLC阳性患者比PLC阴性患者预后差,胸腔冲洗细胞学检查可作为一项独立的预后因素,被纳入到TNM亚组分期中,但受纳入研究数量和质量的限制,上述结论尚需开展更多高质量的研究进行验证。

Objective To systematically evaluate the effectiveness of intraoperative pleural lavage cytology（PLC） positive and negative on mortality,recurrence and relapse rate in five years after pneumonectomy in patients with non-small cell lung cancer（NSCLC）.Methods We searched PubMed,EMBASE, Cochrane, library, CNKI, VIP, and Wanfang Data databases to collect cohort study of the prognosis of pneumonectomy in patients with NSCLC from construction of database to November 2017. RevMan 5.3 software was used to process the data, and to figure out the risk ratio （RR） and 95% of the confidence intervals （confidence interval, CI ）.Results A total of 11 retrospective controlled studies were conducted, including 11 856 patients with NSCLC,among which, 533 were positive PLC patients and 11 323 were PLC negative patients. The Meta analysis results showed that,compared to PLC negtive patients were not only associated with poor survival rate, but also with recurrence and metastasis, especially pleural metastasis. The total mortality rate （ RR = 1.99 , 95% CI = 1.84 - 2.14 , P 〈 0.01 ） and the mortality rate of stage Ⅰ（clinical staging of non-small cell lung cancer, RR = 2.10 , 95% CI = 1.85 - 2.39 , P 〈 0.01 ） five years after the pulmonary resection , the total relapse rate （ RR = 2.54 , 95% CI = 2.21 - 2.92 , P 〈 0.01 ） pleural metastasis （ RR = 8.17 , 95% CI = 6.02 - 11.10 , P 〈 0.01 ）, and the distant recurrence of the two groups were all of statistical significance（ RR = 2.65 ,95% CI = 2.12 - 3.31 , P 〈 0.01 ）.Conclusion The prognosis of patients with positive PLC is worse than that of patients with negative PLC, and PLC can serve as an independent prognostic factor in NSCLC patients. Given that the quantity and quality of the inclued studies are limited, the above conclusion still needs to be verified by higher quality studies.