新辅助治疗后至少12枚淋巴结对直肠癌预后的影响：一项荟萃分析。

Prognostic impact of at least 12 lymph nodes after neoadjuvant therapy in rectal cancer: A meta-analysis.

作者信息

Tan Ling, Liu Zi-Lin, Ma Zhou, He Zhou, Tang Lin-Han, Liu Yi-Lei, Xiao Jiang-Wei

机构信息

Department of Gastrointestinal Surgery, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China.

出版信息

World J Gastrointest Oncol. 2020 Dec 15;12(12):1443-1455. doi: 10.4251/wjgo.v12.i12.1443.

DOI:10.4251/wjgo.v12.i12.1443

PMID:33362914

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7739152/

Abstract

BACKGROUND

The number of dissected lymph nodes (LNs) in rectal cancer after neoadjuvant therapy has a controversial effect on the prognosis.

AIM

To investigate the prognostic impact of the number of LN dissected in rectal cancer patients after neoadjuvant therapy.

METHODS

We performed a systematic review and searched PubMed, Embase (Ovid), MEDLINE (Ovid), Web of Science, and Cochrane Library from January 1, 2000 until January 1, 2020. Two reviewers examined all the publications independently and extracted the relevant data. Articles were eligible for inclusion if they compared the number of LNs in rectal cancer specimens resected after neoadjuvant treatment (LNs ≥ 12 LNs < 12). The primary endpoints were the overall survival (OS) and disease-free survival (DFS).

RESULTS

Nine articles were included in the meta-analyses. Statistical analysis revealed a statistically significant difference in OS [hazard ratio (HR) = 0.76, 95% confidence interval (CI): 0.66-0.88, = 12.2%, = 0.336], DFS (HR = 0.76, 95%CI: 0.63-0.92, = 68.4%, = 0.013), and distant recurrence (DR) (HR = 0.63, 95%CI: 0.48-0.93, = 30.5%, = 0.237) between the LNs ≥ 12 and LNs < 12 groups, but local recurrence (HR = 0.67, 95%CI: 0.38-1.16, = 0%, = 0.348) showed no statistical difference. Moreover, subgroup analysis of LN negative patients revealed a statistically significant difference in DFS (HR = 0.67, 95%CI: 0.52-0.88, = 0%, = 0.565) between the LNs ≥ 12 and LNs < 12 groups.

CONCLUSION

Although neoadjuvant therapy reduces LN production in rectal cancer, our data indicate that dissecting at least 12 LNs after neoadjuvant therapy may improve the patients' OS, DFS, and DR.

摘要

背景

新辅助治疗后直肠癌患者的淋巴结清扫数量对预后的影响存在争议。

目的

探讨新辅助治疗后直肠癌患者淋巴结清扫数量对预后的影响。

方法

我们进行了一项系统评价，检索了2000年1月1日至2020年1月1日期间的PubMed、Embase（Ovid）、MEDLINE（Ovid）、Web of Science和Cochrane图书馆。两名评价者独立审查所有出版物并提取相关数据。如果文章比较了新辅助治疗后切除的直肠癌标本中的淋巴结数量（淋巴结≥12个与淋巴结<12个），则符合纳入标准。主要终点为总生存期（OS）和无病生存期（DFS）。

结果

9篇文章纳入荟萃分析。统计分析显示，淋巴结≥12个组与淋巴结<12个组在OS[风险比（HR）=0.76，95%置信区间（CI）：0.66-0.88，P=12.2%，I²=0.336]、DFS（HR=0.76，95%CI：0.63-0.92，P=68.4%，I²=0.013）和远处复发（DR）（HR=0.63，95%CI：0.48-0.93，P=30.5%，I²=0.237）方面存在统计学显著差异，但局部复发（HR=0.67，95%CI：0.38-1.16，P=0%，I²=0.348）无统计学差异。此外，对淋巴结阴性患者的亚组分析显示，淋巴结≥12个组与淋巴结<12个组在DFS方面存在统计学显著差异（HR=0.67，95%CI：0.52-0.88，P=0%，I²=0.565）。