淋巴结清扫对肝内胆管癌预后价值的Meta分析

Prognostic value of lymph node dissection for intrahepatic cholangiocarcinoma:A meta-analysis

目的评价淋巴结清扫(LND)对肝内胆管癌患者预后的影响。方法检索2012年1月至2022年10月间PubMed、EmBase、Web of Science、Cochrane、万方数据、中国知网数据库收录的文献,将肝内胆管癌手术治疗患者分为淋巴结清扫组(LND+组)及未行淋巴结清扫组(LND-组)。分析LND对患者预后的影响。结果共纳入21篇文献5449例患者。LND并未改善患者总生存期(OS),清扫淋巴结阳性组(N1组)患者OS低于LND-组(HR=2.75,95%CI:1.73~4.36,P<0.05),清扫淋巴结阴性组(N0组)患者OS高于N1组患者(HR=0.35,95%CI:0.31~0.40,P<0.001),与LND-组患者OS差异无统计学意义。亚组分析结果提示,LND能显著提高R0切除亚组中患者的OS(HR=0.60,95%CI:0.44~0.81,P<0.01),但并不能改善临床淋巴结阴性亚组和非R0切除亚组患者的OS;R0切除亚组中,N0组患者OS高于LND-组(HR=0.75,95%CI:0.58~0.97,P<0.05)。LND+组并发症发生率显著高于LND-组(OR=1.88,95%CI:1.35~2.62,P<0.001),两组患者间术后复发率差异无统计学意义。结论LND使临床淋巴结阴性肝内胆管癌患者生存获益并不明显,但在不明确是否存在系统性转移的情况下,常规LND可能是更加保守的方式。

Objective To investigate the prognostic value of lymph node dissection(LND)for intrahepatic cholangiocarcinoma(ICC)patients.Methods From January 2012 to October 2022,the literature included in PubMed,EmBase,Web of Science,Cochrane,Wanfang Data,and CNKI database was retrieved.The literature required that the surgical intervention of ICC was divided into two groups:lymph node dissection(LND+group)and non-lymph node dissection(LND-group)to analyze the effect of lymph node dissection on patient outcomes.Results A total of 5449 patients from 21 studies were included,and the results of meta-analysis showed that LND did not improve the overall survival(OS).OS of patients in the N1 group was lower than that in the LND-group(HR=2.75,95%CI:1.73-4.36,P<0.05),and the OS of N0 group was higher than that of N1 group(HR=0.35,95%CI:0.31-0.40,P<0.001),which was not significantly different from the LND-group.Subgroup analysis showed that LND significantly increased OS of the R0 resection subgroup(HR=0.60,95%CI:0.44-0.81,P<0.01),but did not improve OS of the clinically lymph node metastasis subgroup and non-R0 resection subgroup,and the OS of patients in the N0 group was higher than that in the LND-group(HR=0.75,95%CI:0.58-0.97,P<0.05).The complication rate in the LND+group was significantly higher than that in the LND-group(OR=1.88,95%CI:1.35-2.62,P<0.001).There was no statistically significant difference in postoperative recurrence rates between two groups.Conclusion The survival benefi t of LND in patients with clinically node-negative ICC is not obvious,but routine LND may be a more conservative way when it is not clear whether systemic metastasis exists.