接受细胞减灭术的晚期上皮性卵巢癌合并心膈淋巴结肿大患者的生存情况：一项系统评价和荟萃分析
Survival in Advanced-Stage Epithelial Ovarian Cancer Patients with Cardiophrenic Lymphadenopathy Who Underwent Cytoreductive Surgery: A Systematic Review and Meta-Analysis.
作者信息
Kengsakul Malika, Nieuwenhuyzen-de Boer Gatske M, Bijleveld Anna H J, Udomkarnjananun Suwasin, Kerr Stephen J, Niehot Christa D, van Beekhuizen Heleen J
机构信息
Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands.
Panyananthaphikkhu Chonprathan Medical Center, Department of Obstetrics and Gynecology, Srinakharinwirot University, Nonthaburi 11120, Thailand.
出版信息
Cancers (Basel). 2021 Oct 7;13(19):5017. doi: 10.3390/cancers13195017.
PURPOSE
To evaluate the clinical outcomes of enlarged cardiophrenic lymph node (CPLN) in advanced-stage epithelial ovarian cancer (AEOC) patients who underwent cytoreductive surgery.
METHODS
The Embase, Medline, Web of Science, Cochrane Library, and Google Scholar databases were searched for articles from the database inception to June 2021. Meta-analysis was conducted to determine the prognostic impact of surgical outcome, postoperative complication, and survival using random-effects models.
RESULTS
A total of 15 studies involving 727 patients with CPLN adenopathy and 981 patients without CPLN adenopathy were included. The mean size of preoperative CPLN was 9.1± 3.75 mm. Overall, 82 percent of the resected CPLN were histologically confirmed pathologic nodes. Surgical outcomes and perioperative complications did not differ between both groups. The median OS time was 42.7 months (95% CI 10.8-74.6) vs. 47.3 months (95% CI 23.2-71.2), in patients with and without CPLN adenopathy, respectively. At 5 years, patients with CPLN adenopathy had a significantly increased risk of disease recurrence (HR 2.14, 95% CI 1.82-2.52, < 0.001) and dying from the disease (HR 1.74, 95% CI 1.06-2.86, = 0.029), compared with those without CPLN adenopathy. CPLN adenopathy was significantly associated with ascites (OR 3.30, 95% CI 1.90-5.72, < 0.001), pleural metastasis (OR 2.58, 95% CI 1.37-4.82, = 0.003), abdominal adenopathy (OR 2.30, 95% CI 1.53-3.46, < 0.001) and extra-abdominal metastasis (OR 2.30, 95% CI 1.61-6.67, = 0.001).
CONCLUSIONS
Enlarged CPLN in preoperative imaging is highly associated with metastatic involvement. Patients with CPLN adenopathy had a lower survival rate, compared with patients without CPLN adenopathy. Further randomized controlled trials should be conducted to definitively demonstrate whether CPLN resection at the time of cytoreductive surgery is beneficial.
目的
评估晚期上皮性卵巢癌（AEOC）患者在接受细胞减灭术后肿大的心膈淋巴结（CPLN）的临床结局。
方法
检索Embase、Medline、Web of Science、Cochrane图书馆和谷歌学术数据库，查找从数据库建立至2021年6月的文章。采用随机效应模型进行荟萃分析，以确定手术结局、术后并发症和生存的预后影响。
结果
共纳入15项研究，涉及727例有CPLN病变的患者和981例无CPLN病变的患者。术前CPLN的平均大小为9.1±3.75毫米。总体而言，82%的切除CPLN经组织学证实为病理淋巴结。两组的手术结局和围手术期并发症无差异。有和无CPLN病变的患者的中位总生存期分别为42.7个月（95%CI 10.8 - 74.6）和47.3个月（95%CI 23.2 - 71.2）。与无CPLN病变的患者相比，有CPLN病变的患者在5年时疾病复发风险显著增加（HR 2.14，95%CI 1.82 - 2.52，<0.001），死于该疾病的风险也显著增加（HR 1.74，95%CI 1.06 - 2.86，=0.029）。CPLN病变与腹水（OR 3.30，95%CI 1.90 - 5.72，<0.001）、胸膜转移（OR 2.58，95%CI 1.37 - 4.82，=0.003）、腹部淋巴结病变（OR 2.30，95%CI 1.53 - 3.46，<0.001）和腹外转移（OR 2.30，95%CI 1.61 - 6.67，=0.001）显著相关。
结论
术前影像学检查中肿大的CPLN与转移累及高度相关。与无CPLN病变的患者相比，有CPLN病变的患者生存率较低。应进行进一步的随机对照试验，以明确证明细胞减灭术时切除CPLN是否有益。
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