进展期直肠癌侧方淋巴结清扫对预后影响Meta分析

Prognosis of lateral lymph node dissection with radical surgery for advanced lower rectal cancer:A metaanalysis

目的评估侧方淋巴结清扫(LLND)对进展期低位直肠癌病人术后存活、复发及转移的影响。方法检索Pubmed、EMbase、Cochrane library、中国学术期刊全文数据库等中英文数据库中的文献,纳入2000年1月至2018年6月与进展期低位直肠癌预后相关的临床对照研究,运用Stata/SE软件进行Meta分析,评估LLND对进展期低位直肠癌病人5年总存活率、5年无复发存活率、局部复发率、术后泌尿功能障碍发生率的影响。结果纳入文献17篇共5631例病人。LLND组术后5年总存活率(HR=1.19,95%CI 0.98~1.43,P=0.902)、5年无复发存活率(HR=0.98,95%CI 0.82~1.17,P=0.794)、局部复发率(HR=0.93,95%CI 0.67~1.31,P=0.694)与非LLND组相比差异无统计学意义;LLND组术后泌尿功能障碍发生率高于非LLND组,差异有统计学意义(OR=4.08,95%CI 1.94~8.59,P<0.01)。结论对于进展期低位直肠癌病人,LLND并不能改善术后生存等远期预后指标,但增加术后泌尿功能障碍发生率。

Objective To evaluate the clinical outcome and prognosis of lateral lymph node dissection （LLND） in advanced lower rectal cancer. Methods Pubmed, EMbase and Cochrane Library were retrieved for related studies published between 2001 to 2017. Enrolled studies that compared the prognosis of LLND surgery plus radical surgery and radical surgery alone were collected in the meta-analysis and analyzed by Stata SE. Random or fixed-effects meta-analytical models was carried according to the degree of heterogeneity. Long-term prognosis like 5-year survival, local recurrence rate and the incidence of urinary dysfunction were assessed. Results A total of 17 clinical comparative studies （including 5631 patients） were included in the study. Meta-analysis shows that there was no significant difference between LLND group and non LLND group in 5-year overall survival （HR=1.19, 95% CI 0.98-1.43, P= 0.902） , 5-year relapse-free survival （HR=0.98,95% CI 0.82-1.17, P=0.794） and local recurrence （HR=0.93,95% CI 0.67-1.31, P=0.694）. Significant higher incidence of urinary dysfunction was found in LLND group （OR=4.08, 95%CI1.94-8.59, P 〈 0.01 ）. Conclusion LLND increases the incidence of postoperative urinary dysfunction, but not improve the long-term prognosis of the patients with lower rectal cancer.