淋巴结获取数目对食管癌患者总生存预后价值的系统评价和荟萃分析。

Prognostic Value of Lymph Node Yield on Overall Survival in Esophageal Cancer Patients: A Systematic Review and Meta-analysis.

机构信息

Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

Department of Surgery and Cancer, Imperial College London, London, UK.

出版信息

Ann Surg. 2019 Feb;269(2):261-268. doi: 10.1097/SLA.0000000000002824.

DOI:10.1097/SLA.0000000000002824

PMID:29794846

Abstract

OBJECTIVE

This meta-analysis determines whether increased lymph node yield improves survival in patients with esophageal cancer undergoing esophagectomy with or without neoadjuvant therapy.

BACKGROUND

Esophagectomy involves resection of the esophagus and surrounding lymph nodes, which are commonly the first stations of cancer spread. The extent of lymphadenectomy during esophagectomy remains controversial, with several studies publishing conflicting results, especially in the era of neoadjuvant therapy.

METHODS

An electronic literature search was undertaken using Embase, Medline, and the Cochrane library databases (2000 to 2017). Articles with esophageal cancer patients undergoing esophagectomy with lymphadenectomy and investigating the effects of low and high lymph node yield on overall survival and disease-free survival were included. Meta-analysis of data was conducted using a random effects model. If the study divided the cohort into multiple groups based on lymph node yield, survival was compared between the lowest and highest lymph node yield groups. In addition to analysis of the entire cohort, subset analysis of only those patients receiving neoadjuvant therapy was also performed.

RESULTS

A total of 26 studies were included in this meta-analysis with a follow-up ranging from 15 to 94 months. For the analysis of overall survival, 23 studies were included. A meta-analysis showed that overall survival significantly improved in the high lymph node yield group [hazard ratio (HR) = 0.81; 95% confidence interval (95% CI) = 0.74-0.87; P < 0.01]. In the 10 studies describing disease-free survival, this was significantly improved in the high lymph node yield group (HR = 0.72; 95% CI = 0.62-0.84; P < 0.01). Subset analysis of neoadjuvant-treated patients demonstrated a survival benefit of high lymph node yield on overall survival (HR = 0.82; 95% CI = 0.73-0.92; P < 0.01).

CONCLUSION

This meta-analysis demonstrates the benefit of an increased lymph node yield from esophagectomy on overall and disease-free survival. In addition, a survival benefit of a high lymph node yield was demonstrated in patients receiving neoadjuvant therapy followed by esophagectomy.

摘要

目的

本荟萃分析旨在确定在接受食管癌切除术（包括新辅助治疗和不包括新辅助治疗）的患者中，增加淋巴结检出量是否能改善生存。

背景

食管癌切除术涉及食管和周围淋巴结的切除，淋巴结通常是癌症扩散的第一站。食管癌切除术的淋巴结清扫范围仍存在争议，多项研究发表的结果相互矛盾，尤其是在新辅助治疗时代。

方法

使用 Embase、Medline 和 Cochrane 图书馆数据库（2000 年至 2017 年）进行电子文献检索。纳入了行淋巴结清扫术的食管癌患者的研究，并探讨了低淋巴结检出量和高淋巴结检出量对总生存率和无病生存率的影响。使用随机效应模型对数据进行荟萃分析。如果研究根据淋巴结检出量将队列分为多个组，则比较最低和最高淋巴结检出量组之间的生存情况。除了对整个队列进行分析外，还对仅接受新辅助治疗的患者进行了亚组分析。

结果

本荟萃分析共纳入 26 项研究，随访时间为 15 至 94 个月。对于总生存率分析，共纳入 23 项研究。荟萃分析显示，高淋巴结检出量组的总生存率显著提高[风险比（HR）=0.81；95%置信区间（95%CI）=0.74-0.87；P<0.01]。在描述无病生存率的 10 项研究中，高淋巴结检出量组的无病生存率显著提高（HR=0.72；95%CI=0.62-0.84；P<0.01）。新辅助治疗患者的亚组分析显示，高淋巴结检出量对总生存率有生存获益（HR=0.82；95%CI=0.73-0.92；P<0.01）。