系统性淋巴结清扫术对卵巢癌预后影响的系统评价

Prognostic efficacy of systematic lymphadenectomy for ovarian cancer:a systematic review

目的系统评价系统性淋巴结清扫术(SL)治疗卵巢癌患者的预后效果和安全性。方法计算机检索PubMed、The Cochrane Library、Web of Science、CNKI、WanFang Data和CBM数据库,搜集SL治疗卵巢癌患者的随机对照试验(RCT)与队列研究,检索时限均从建库至2020年12月16日。由6名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果最终纳入5篇RCT和23篇队列研究,包括6166例患者。Meta分析结果显示:SL组与非系统性淋巴结清扫术(NSL)组卵巢癌患者的3年生存率、5年生存率、3年无进展生存率及5年无进展生存率的差异均无统计学意义。亚组分析结果显示,盆腔与腹主动脉旁淋巴结清扫术联合大网膜切除患者的预后较好。结论当前证据显示,SL对卵巢癌患者生存率和无进展生存率均无显著影响。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the prognostic efficacy and safety of patients with ovarian cancer treated with systemic lymphadenectomy(SL).Methods PubMed,The Cochrane Library,Web of Science,CNKI,WanFang Data,and CBM databases were electronically searched to collect randomized controlled trials(RCTs)and cohort studies on the prognostic outcomes of patients with ovarian cancer treated with SL from inception to December 16th,2020.Six reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies.Meta-analysis was then performed using RevMan 5.4 software.Results A total of 5 RCTs and 23 cohort studies involving 6166 patients were included.The results of meta-analysis showed that there were no significant differences in the 3-year survival rate,5-year survival rate,3-year progression-free survival rate,and 5-year progression-free survival rate between SL group and the no systemic lymphadenectomy(NSL)group.The results of the subgroup analysis showed that pelvic and para-aortic lymph node dissection combined with large omentum resection had a better prognosis for patients.Conclusions Current evidence shows that SL has no significant efficacy on survival and progression-free survival in patients with ovarian cancer.Due to limited quality and quantity of the included studies,more high-quality studies are required to verify the above conclusions.