在治疗早期非小细胞肺癌时，肺叶特异性淋巴结清扫术能否替代系统性淋巴结清扫术：一项全面的系统评价和荟萃分析？
Can lobe-specific lymph node dissection be an alternative to systematic lymph node dissection in treating early-stage non-small cell lung cancer: a comprehensive systematic review and meta-analysis?
作者信息
Deng Han-Yu, Qin Chang-Long, Li Gang, Alai Guha, Lin Yidan, Qiu Xiao-Ming, Zhou Qinghua
机构信息
Lung cancer center, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of thoracic surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
出版信息
J Thorac Dis. 2018 May;10(5):2857-2865. doi: 10.21037/jtd.2018.04.137.
BACKGROUND
Whether lobe-specific lymph node dissection (L-SLND) could serve as an alternative to systematic lymph node dissection (SLND) in treating early-stage non-small cell lung cancer (NSCLC) remains unclear. Therefore, we conducted this comprehensive meta-analysis to compare the effect of L-SLND with that of SLND in treating early-stage NSCLC.
METHODS
A systematic literature search in PubMed and Embase was conducted to identify relevant studies up to 30 November 2017. Data including 5-year overall survival (OS) and disease-free survival (DFS) rates, recurrence rates, and morbidity rate were extracted and analysed.
RESULTS
A total of six studies [one randomized controlled trial (RCT) and five retrospective cohort studies] consisting of 2,037 patients with early-stage NSCLC were included for analysis. Meta-analysis showed that there was no significant difference of 5-year OS [81.7% and 79.5%, respectively; risk ratio (RR) =1.021; 95% confidence interval (CI), 0.977-1.068; P=0.352] and DFS (76.4% and 69.9%, respectively; RR =1.061; 95% CI, 0.999-1.128; P=0.054) between patients treated with L-SLND and those with SLND. Moreover, there was also no significant difference of total recurrence rates (24.3% and 25.8%, respectively; RR =0.892; 95% CI, 0.759-1.048; P=0.166) and loco-regional recurrence rates (7.9% and 9.3%, respectively; RR =0.851; 95% CI, 0.623-1.162; P=0.310) between patients treated with L-SLND and those with SLND. However, patients treated with L-SLND yielded a significant lower morbidity rate than those treated with SLND (10.2% and 13.5%, respectively; RR =0.681; 95% CI, =0.521-0.888; P=0.005).
CONCLUSIONS
L-SLND yielded a significantly lower risk of morbidity compared to SLND without compromising long-term oncologic outcomes based on available studies with relatively poor quality. L-SLND may serve as an alternative to SLND in treating early-stage NSCLC. Further well-conducted RCTs, however, are badly needed to confirm and update our conclusions.
背景
在治疗早期非小细胞肺癌（NSCLC）时，肺叶特异性淋巴结清扫术（L-SLND）能否替代系统性淋巴结清扫术（SLND）尚不清楚。因此，我们进行了这项综合荟萃分析，以比较L-SLND与SLND治疗早期NSCLC的效果。
方法
在PubMed和Embase上进行系统文献检索，以识别截至2017年11月30日的相关研究。提取并分析包括5年总生存率（OS）和无病生存率（DFS）、复发率及发病率的数据。
结果
共纳入6项研究[1项随机对照试验（RCT）和5项回顾性队列研究]，包括2037例早期NSCLC患者进行分析。荟萃分析显示，接受L-SLND治疗的患者与接受SLND治疗的患者在5年OS[分别为81.7%和79.5%；风险比（RR）=1.021；95%置信区间（CI），0.977 - 1.068；P = 0.352]和DFS[分别为76.4%和69.9%；RR = 1.061；95% CI，0.999 - 1.128；P = 0.054]方面无显著差异。此外，接受L-SLND治疗的患者与接受SLND治疗的患者在总复发率[分别为24.3%和25.8%；RR = 0.892；95% CI，0.759 - 1.048；P = 0.166]和局部区域复发率[分别为7.9%和9.3%；RR = 0.851；95% CI，0.623 - 1.162；P = 0.310]方面也无显著差异。然而，接受L-SLND治疗的患者发病率显著低于接受SLND治疗的患者（分别为10.2%和13.5%；RR = 0.681；95% CI，0.521 - 0.888；P = 0.005）。
结论
基于现有质量相对较差的研究，与SLND相比，L-SLND在不影响长期肿瘤学结局的情况下，发病率风险显著更低。L-SLND可能作为治疗早期NSCLC时SLND的一种替代方法。然而，迫切需要进一步开展设计良好的RCT来证实和更新我们的结论。
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