腹腔镜评估晚期卵巢癌患者能否行满意的肿瘤细胞减灭术的Meta分析

Laparoscopy for diagnosing resectability of disease in patients with advanced ovarian cancer:a Meta-analysis

目的评价腹腔镜对晚期卵巢癌患者能否行满意的肿瘤细胞减灭术的诊断价值。方法计算机检索Pub Med、Embase、Cochrane Library、中国知网(CNKI)、中国生物医学文摘数据库(CBM)、万方全文数据库。检索时间从1990-01-01到2016-06-01。提取相关数据并应用QUADAS-2工具评价文献质量。对所有研究予以加权定量合并,计算敏感度、特异度及其95%CI。绘制综合受试者工作特征曲线(SROC)。对纳入文献行敏感性分析。结果本研究共纳入11篇文献,累计腹腔镜评估1279例患者。敏感度对数与(1-特异度)对数的Spearman相关系数=-0.336,P=0.312,提示纳入研究不存在阈值效应。汇总敏感度、特异度、诊断比值比分别为100%(95%CI:99%~100%)、79%(95%CI:76%~82%)、326.43(95%CI:125.53~848.85)。SROC曲线下面积(AUC)=0.9917(SE=0.0072)。敏感性分析显示纳入的11篇文献稳定性好,结果可信。结论腹腔镜对晚期卵巢癌患者能否行满意的肿瘤细胞减灭术的评估效能较高,是一种很有前途的探查方式。

Objective To investigate whether laparoscopy can be considered as adequate and reliable as standard laparotomy in predicting optimal cytoreduction in patients with advanced ovarian cancer. Methods Pub Med, Embase,Cochrane Library, CNKI, China Biology Medicine(CBM), Wanfang database were retrieved for literatures on the laparoscopy for diagnosing resectability of advanced ovarian cancer from 1st January 1990 to 1st June 2016. The quality of included studies were assessed based on the QUADAS-2. All of the included articles were calculated pooled weighted sensitivity, specificity and 95%CI. Summary receiver operating characteristic(SROC) curve was made and sensitivity analysis was performed. Results Eleven studies were included in the Meta-analysis involving 1279 patients. Spearman correlation were-0.336 and P=0.312. There was no threshold effect in all studies. The pooled sensitivity, specificity and diagnostic ratio odds were 100%(95%CI:99%-100%), 79%(95%CI: 76%-82%), 326.43(95%CI:125.53-848.85). AUC of SROC=0.9917(SE=0.0072). The AUC of SROC didn't change much when we removed the included studies one by one, and then do the Meta-analyses again. It meant that the quality of all included studies was reliable.Conclusion Laparoscopy showed good accuracy in evaluation satisfactory cytoreductive surgery on patients with advanced ovarian cancer and it is a promising exploration method.