在中、高危前列腺癌中扩大与标准淋巴清扫术疗效对比的Meta分析

Meta analysis of the efficacy of extended and standard lymphadenectomy in moderate and high-risk prostate cancer

目的比较中、高危风险前列腺癌患者中行扩大淋巴清扫术(ePLND)与标准淋巴清扫术(sPLND)的疗效及安全性。方法通过计算机检索Pubmed、Embase、Cochrane数据库中符合条件的研究。检索时间从各数据库建库开始至2020年3月1日为止。采用国际Cochrane协作网推荐的系统评价软件RevMan 5.3进行Meta分析。结果本研究共纳入8项研究,其中1项前瞻性队列研究,7项回顾性对照试验。Meta分析显示:ePLND术后能切除更多的淋巴结[MD=10.11,95%CI:8.15~12.07,P<0.001],也能发现更多的阳性淋巴结[OR=4.00,95%CI:2.92~5.48,P<0.001];虽然行ePLND所需时间较长[OR=12.54,95%CI:10.44~14.63,P<0.001],但是两种手术方式导致的并发症发生率比较,差异无统计学意义[OR=1.78,95%CI:0.61~5.19,P=0.29]。就肿瘤学相关结果而言,ePLND和sPLND术后肿瘤的生化复发率(P=0.75)及患者的无生化复发生存率比较,差异无统计学意义(P=0.09)。结论在中、高危前列腺癌患者中,ePLND确实能完善病理分级、肿瘤分期,且不会增加并发症的发生率,推荐对中、高危前列腺癌患者行ePLND,但淋巴清扫范围对患者预后的影响仍需长期随访。

Objective To compare the curative effect of extended pelvic lymph node dissection(ePLND)and standard pelvic lymph node dissection(sPLND)in patients who are in moderate and high-risk prostate cancer(PCa).Methods After retrieving the Pubmed,Embase and Cochrane Library,all control trials comparing ePLND with sPLND in moderate and high-risk PCa were included.A systematic Meta-analysis was performed by Review Manager 5.3.Results A total of eight studies were included,of which only one was experimental,the other studies were cohort studies.Meta-analysis showed that more lymph nodes were removed after ePLND(MD=10.11,95%CI:8.15-12.07,P<0.001),and more positive lymph nodes were found(OR=4.00,95%CI:2.92-5.48,P<0.001).There was no difference in the incidence of complications between the two surgical procedures,despite the longer duration of ePLND(OR=12.54,95%CI:10.44-14.63,P<0.001).In terms of oncological results,there was no significant difference in biochemical recurrence rate(P=0.75)or biochemical relapse-free survival rate(P=0.09)between ePLND.Conclusions In moderate and high-risk prostate cancer patients,ePLND can improve pathological grade and tumor staging without increasing the incidence of complications.Therefore,ePLND is recommended for moderate and high-risk prostate cancer patients.However,long-term follow-up is still needed to determine the effect of the range of lymphatic dissection on the prognosis of patients.