Qi Wenqiang, Zhong Minglei, Jiang Ning, Zhou Yongheng, Lv Guangda, Li Rongyang, Shi Benkang, Chen Shouzhen
Department of Urology, Qilu Hospital of Shandong University, Jinan, China.
Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
Front Oncol. 2022 Nov 25;12:986150. doi: 10.3389/fonc.2022.986150. eCollection 2022.
This study aims to determine the optimal pelvic lymph node dissection (PLND) template for radical cystectomy (RC).
A systematic search was conducted using the PubMed, Embase and Cochrane Library database in December 2021. Articles comparing recurrence-free survival (RFS), disease-specific survival (DSS), overall survival (OS), and postoperative complications among patients undergoing limited PLND (lPLND), standard PLND (sPLND), extended PLND (ePLND), or super-extended PLND (sePLND) were included. A Bayesian approach was used for network meta-analysis.
We included 18 studies in this systematic review, and 17 studies met our criteria for network meta-analysis. We performed meta-analyses and network meta-analyses to investigate the associations between four PLND templates and the RFS, DSS, OS, or postoperative complications. We found that the ePLND group and the sePLND group were associated with better RFS than the sPLND group (Hazard Ratio [HR]: 0.65, 95% Credible Interval [CrI]: 0.56 to 0.78) (HR: 0.67, 95% CrI: 0.56 to 0.83) and the lPLND group (HR: 0.67, 95% CrI: 0.50 to 0.91) (HR: 0.70, 95% CrI: 0.49 to 0.99). For RFS, Analysis of the treatment ranking revealed that ePLND had the highest probabilities to be the best template. There was no significant difference between the four templates in DSS, however, analysis of the treatment ranking indicated that sePLND had the highest probabilities to be the best template. And We found that the sePLND group and the ePLND group were associated with better OS than lPLND (HR: 0.58, 95% CrI: 0.36 to 0.95) (HR: 0.63, 95% CrI: 0.41 to 0.94). For OS, analysis of the treatment ranking revealed that sePLND had the highest probabilities to be the best template. The results of meta-analyses and network meta-analyses showed that postoperative complications rates did not differ significantly between any two templates.
Patients undergoing sePLND and ePLND had better RFS but not better DSS or OS than those undergoing lPLND or sPLND templates, however, RFS did not differ between patients undergoing sePLND or ePLND. Considering that sePLND involves longer operation time, higher risk, and greater degree of difficulty than ePLND, and performing sePLND may not result in better prognosis, so it seems that there is no need for seLPND. We think that ePLND might be the optimal PLND template for RC.
https://www.crd.york.ac.uk/prospero/, identifier CRD42022318475.
本研究旨在确定根治性膀胱切除术（RC）的最佳盆腔淋巴结清扫术（PLND）模板。
于2021年12月使用PubMed、Embase和Cochrane图书馆数据库进行系统检索。纳入比较接受有限PLND（lPLND）、标准PLND（sPLND）、扩大PLND（ePLND）或超扩大PLND（sePLND）的患者的无复发生存期（RFS）、疾病特异性生存期（DSS）、总生存期（OS）和术后并发症的文章。采用贝叶斯方法进行网络荟萃分析。
本系统评价纳入18项研究，17项研究符合我们的网络荟萃分析标准。我们进行了荟萃分析和网络荟萃分析，以研究四种PLND模板与RFS、DSS、OS或术后并发症之间的关联。我们发现，ePLND组和sePLND组的RFS优于sPLND组（风险比[HR]：0.65，95%可信区间[CrI]：0.56至0.78）（HR：0.67，95%CrI：0.56至0.83）和lPLND组（HR：0.67，95%CrI：0.50至0.91）（HR：0.70，95%CrI：0.49至0.99）。对于RFS，治疗排名分析显示ePLND成为最佳模板的概率最高。四种模板在DSS方面无显著差异，然而，治疗排名分析表明sePLND成为最佳模板的概率最高。并且我们发现sePLND组和ePLND组的OS优于lPLND（HR：0.58，95%CrI：0.36至0.95）（HR：0.63，95%CrI：0.41至0.94）。对于OS，治疗排名分析显示sePLND成为最佳模板的概率最高。荟萃分析和网络荟萃分析结果显示，任意两种模板之间的术后并发症发生率无显著差异。
与接受lPLND或sPLND模板的患者相比，接受sePLND和ePLND的患者RFS更好，但DSS或OS并无改善，然而，接受sePLND或ePLND的患者之间RFS无差异。考虑到sePLND比ePLND手术时间更长、风险更高、难度更大，且进行sePLND可能不会带来更好的预后，因此似乎没有必要进行seLPND。我们认为ePLND可能是RC的最佳PLND模板。
