Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, China.
Br J Radiol. 2012 Nov;85(1019):e1110-9. doi: 10.1259/bjr/12500248. Epub 2012 Jun 14.
The objective of this study was to pool the lymph node metastasis rate (LNMR) in patients with thoracic oesophageal cancer (TOC) and to determine which node level should be included when undergoing radiation therapy.
Qualified studies were identified on Medline, Embase, CBM and the Cochrane Library through to the end of April 2011. Pooled estimates of LNMR were obtained through a random-effect model. Possible effect modifiers which might lead to the statistical heterogeneity were identified through meta-regression, and further subgroup analyses of factors influencing LNMR were performed.
45 observational studies with a total of 18 415 patients were included in the meta-analysis. The pooled estimates of LNMR in upper, middle and lower TOC were 30.7%, 16.8% and 11.0% cervical, 42.0%, 21.1% and 10.5% upper mediastinal, 12.9%, 28.1% and 19.6% middle mediastinal, 2.6%, 7.8% and 23.0% lower mediastinal, and 9%, 21.4% and 39.9% abdominal, respectively. Lymph node metastasis most frequently happened to paratracheal, paraoesophageal, perigastric 106recR and station 7. The most obvious difference (≥15%) of LNMR between two-field and three-field lymphatic dissection occurred in cervical, paratracheal, 106recR and 108.
Through the meta-analysis, more useful information was obtained about clinical target volume (CTV) delineation of TOC patients treated with radiotherapy. However, our study is predominantly a description of squamous carcinoma and the results may not be valid for adenocarcinoma.
本研究旨在汇总胸段食管鳞癌（胸段食管癌）患者的淋巴结转移率（LNM），并确定在接受放疗时应包括哪些淋巴结水平。
通过 Medline、Embase、CBM 和 Cochrane 图书馆检索 2011 年 4 月底前的合格研究。通过随机效应模型获得 LNM 的汇总估计值。通过荟萃回归识别可能导致统计学异质性的可能的效应修饰因子，并进一步进行影响 LNM 的因素的亚组分析。
纳入了 45 项观察性研究，共计 18415 例患者。汇总分析显示，胸段食管癌颈段、中上段和中下段的 LNM 率分别为 30.7%、16.8%和 11.0%、42.0%、21.1%和 10.5%、12.9%、28.1%和 19.6%、2.6%、7.8%和 23.0%、9%、21.4%和 39.9%。淋巴结转移最常发生于气管旁、食管旁、胃周 106recR 和站 7。二野和三野淋巴结清扫之间 LNM 率差异最明显（≥15%）的部位是颈段、气管旁、106recR 和 108。
通过荟萃分析，获得了关于接受放疗的胸段食管癌患者的临床靶区（CTV）勾画的更有用的信息。然而，本研究主要是对鳞癌的描述，结果可能不适用于腺癌。
