扩大盆腔淋巴结清扫术对临床局限性前列腺癌患者有效性和安全性的Meta分析

The efficacy and safety on extented pelvic lymph node dissection for patients with clinically localized prostate cancer: a systematic review and Meta-analysis

目的:探讨根治性前列腺切除术联合扩大盆腔淋巴结清扫术(ePLND)对临床局限性前列腺癌患者的应用价值。方法:通过计算机检索PubMed、Embase、Cochrane Library、中国知网(CNKI)、万方数据库以及中国生物医学文献电子数据库(CBM),英文检索词包括prostate neoplasms、prostate neoplasm、prostatic neoplasm、prostate cancer、prostate cancers、cancer of the prostate、prostatic cancer、prostatic cancers、cancer of prostate、lymph node excisions、lymphadenectomy、lymphadenectomies、lymph node dissections、radical prostatectomy、extent、extented、standard、standardized、limit、limited,中文检索词包括前列腺癌、根治性前列腺切除术、淋巴结清扫。检索从建库至2020年1月所有对比应用根治性前列腺切除术联合ePLND与标准(sPLND)或限制盆腔淋巴结清扫(lPLND)治疗临床局限性前列腺癌患者的病例对照研究,由2名研究者独立进行文献筛选、提取相关数据及进行文献质量评价,应用Revman 5.3和Stata 12.0软件对纳入的文献进行Meta分析,用R3.6.0软件进行总生存曲线的合并。将lPLND归入sPLND组,以便对比。结果:纳入14篇文献,共12148例前列腺癌患者。Meta分析结果显示,ePLND组的清扫淋巴结数量和淋巴结阳性率均显著高于sPLND组(清扫淋巴结数量:WMD=9.7,95%CI 6.81~12.63,P<0.05;淋巴结阳性率:RR=2.89,95%CI 2.16~3.86,P<0.05)。与sPLND组相比,ePLND组的总手术并发症发生率较高,但差异无统计学意义(RR=1.39,95%CI 0.95~2.05,P=0.09);ePLND组的生化复发率更低(RR=0.69,95%CI 0.52~0.91,P=0.01),无生化复发生存率更高(HR=0.59,95%CI 0.56~0.63,P<0.05)。总生存曲线显示,随时间的推移,ePLND组和sPLND组生存曲线差异越来越大(HR=0.59,95%CI 0.56~0.63,P<0.05)。结论:与sPLND相比,根治性前列腺切除术联合ePLND对临床局限性前列腺癌患者更有效,并且能提供更好的预后结果。

Objective To explore the application value of radical prostatectomy(RP)combined with extented pelvic lymph node dissection(ePLND)in patients with clinically localized prostate adenocarcinoma.Methods We searched the PubMed,Embase,Cochrane Library databases,the China Knowledge Network(CNKI)database,Wanfang database,Chinese Biomedical Literature Database by computer.The following MeSH terms and their combinations were searched in English and Chinese,respectively:prostate neoplasms,prostate neoplasm,prostatic neoplasm,prostate cancer,prostate cancers,cancer of the prostate,prostatic cancer,prostatic cancers,cancer of prostate,lymph node excisions,lymphadenectomy;lymphadenectomies,lymph node dissections,radical prostatectomy,extent,extented,standard,standardized,limit,limited;prostate cancer,radical prostatectomy,lymph node dissections.The search was set for all case-control studies on the comparison in patients with clinically localized prostate cancer beteeen RP with ePLND with standard(sPLND)or limited PLND(lPLND).Two authors independently screened the literature,extracted relevant literature data,and evaluated the quality of the literature.The software Revman 5.3 and Stata 12.0 were used to perform meta-analysis in this study.The software R 3.6.0 was used to combine the total survival curves.The limited template was included in the sPLND for comparison.Results Fourteen studies with a total of 12,148 patients were included.Compared with sPLND,ePLND significantly improved lymph node yield(LNY)(WMD=9.72,95%CI 6.81-12.63,P<0.05)and the detection of more lymph node positivity of metastasis(LN+)(RR=2.89,95%CI 2.16-3.86,P<0.00001).ePLND increased the complication rate,but the differences were not statistically significant(RR=1.39,95%CI 0.95-2.05,P=0.09).The ePLND group had significantly lower biochemical recurrence(BCR)(RR=0.69,95%CI 0.52-0.91,P=0.01)and higher biochemical-free survival(HR=0.59,95%CI 0.56-0.63,P<0.05).Meanwhile,according to the overall survival,the two groups of curves became more and more distant over time(HR=0.59,95%CI 0.56-0.63,P<0.05).Conlucsions Compared with sPLND,RP combined with ePLDN could be more effective than standard PLND in patients with clinically localized prostate cancer and provides a better prognosis.