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淋巴结清扫术在常见高死亡率实体器官恶性肿瘤中的作用:一项随机对照试验的系统评价和荟萃分析

Role of Lymph Node Dissection in Commonly Diagnosed Solid Organ Malignancies With High Mortality Rates: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

作者信息

Bazargani Soroush, Sanikommu Srivani, Jazayeri Seyed Behzad, Al-Toubat Mohammed, Norez Daniel, Balaji Navin, Sathe Aditya, Kuntz Gretchen, Gautam Shiva, Balaji K C

机构信息

Urology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA.

出版信息

Cureus. 2025 Jul 29;17(7):e88981. doi: 10.7759/cureus.88981. eCollection 2025 Jul.


DOI:10.7759/cureus.88981
PMID:40895915
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12393006/
Abstract

The purpose of this study is to review the literature and compare the outcomes of lymph node dissection (LND), or lymphadenectomy, versus no lymphadenectomy (no LND) and extended lymphadenectomy (ELND) versus standard lymphadenectomy (SLND) in various commonly diagnosed solid malignancies with high mortality rates in the United States. We searched for randomized controlled trials involving high-mortality solid tumors, including prostate, bladder, lung, breast, colorectal, pancreas, liver, endometrial, ovarian, and esophageal cancers, in Medline, Embase, and Cochrane Library. The primary endpoint was overall survival, and secondary endpoints included progression-free survival and complications. We identified 4,436 studies in a database search. Of the 43 eligible clinical trials in this study, 31 studies (72.1%) compared LND versus no LND, and the remaining 12 studies (27.9%) compared ELND versus SLND. None of the studies in either comparative group showed a significant difference in overall or recurrence-free survival, with the exception of one study in breast cancer, where ELND was associated with improved overall survival (HR 1.15, 95% CI 1.01-1.30; p = 0.03) compared to SLND. However, ELND across several cancers may be associated with increased risks of complications compared to SLND. The results from this study could help with counseling patients regarding the role of LND in staging of the disease, rather than improving the outcomes. Despite the heterogeneity of the cancers included in this study, the commonality of the lack of survival benefit of LND in most cancers identifies an opportunity for further understanding and the need for additional research on the impact of metastasis to lymph nodes on cancer outcomes.

摘要

本研究旨在回顾文献,比较在美国各种常见的高死亡率实体恶性肿瘤中,淋巴结清扫术(LND)或淋巴结切除术与不进行淋巴结切除术(无LND)以及扩大淋巴结清扫术(ELND)与标准淋巴结清扫术(SLND)的结果。我们在Medline、Embase和Cochrane图书馆中搜索了涉及高死亡率实体肿瘤的随机对照试验,这些肿瘤包括前列腺癌、膀胱癌、肺癌、乳腺癌、结直肠癌、胰腺癌、肝癌、子宫内膜癌、卵巢癌和食管癌。主要终点是总生存期,次要终点包括无进展生存期和并发症。我们在数据库搜索中识别出4436项研究。在本研究的43项符合条件的临床试验中,31项研究(72.1%)比较了LND与无LND,其余12项研究(27.9%)比较了ELND与SLND。除了一项乳腺癌研究外,两个比较组中的任何研究在总生存期或无复发生存期方面均未显示出显著差异,在该乳腺癌研究中,与SLND相比,ELND与总生存期改善相关(HR 1.15,95%CI 1.01 - 1.30;p = 0.03)。然而,与SLND相比,多种癌症的ELND可能与并发症风险增加相关。本研究结果有助于就LND在疾病分期中的作用为患者提供咨询,而非改善预后。尽管本研究纳入的癌症具有异质性,但大多数癌症中LND缺乏生存获益这一共同点为进一步理解以及对淋巴结转移对癌症预后的影响进行更多研究提供了契机。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d8c1/12393006/42f54c72794d/cureus-0017-00000088981-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d8c1/12393006/355a5fc17d8b/cureus-0017-00000088981-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d8c1/12393006/e0877b73a4a2/cureus-0017-00000088981-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d8c1/12393006/f30a40f50d0a/cureus-0017-00000088981-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d8c1/12393006/8dc762057a98/cureus-0017-00000088981-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d8c1/12393006/6eedb992da8f/cureus-0017-00000088981-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d8c1/12393006/42f54c72794d/cureus-0017-00000088981-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d8c1/12393006/355a5fc17d8b/cureus-0017-00000088981-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d8c1/12393006/e0877b73a4a2/cureus-0017-00000088981-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d8c1/12393006/f30a40f50d0a/cureus-0017-00000088981-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d8c1/12393006/8dc762057a98/cureus-0017-00000088981-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d8c1/12393006/6eedb992da8f/cureus-0017-00000088981-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d8c1/12393006/42f54c72794d/cureus-0017-00000088981-i06.jpg

相似文献

[1]
Role of Lymph Node Dissection in Commonly Diagnosed Solid Organ Malignancies With High Mortality Rates: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

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[2]
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[3]
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[4]
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[5]
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[6]
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[7]
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[8]
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[9]
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[10]
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本文引用的文献

[1]
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CA Cancer J Clin. 2022-1

[2]
Axillary dissection versus axillary observation for low risk, clinically node-negative invasive breast cancer: a systematic review and meta-analysis.

Breast Cancer. 2021-11

[3]
The Usefulness of Lymphadenectomy in Bladder Cancer-Current Status.

Medicina (Kaunas). 2021-4-25

[4]
Limited versus Extended Pelvic Lymph Node Dissection for Prostate Cancer: A Randomized Clinical Trial.

Eur Urol Oncol. 2021-8

[5]
Genetic and Non-Genetic Mechanisms Underlying Cancer Evolution.

Cancers (Basel). 2021-3-18

[6]
Extended Versus Limited Pelvic Lymph Node Dissection During Radical Prostatectomy for Intermediate- and High-risk Prostate Cancer: Early Oncological Outcomes from a Randomized Phase 3 Trial.

Eur Urol. 2021-5

[7]
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Int Immunopharmacol. 2020-7

[8]
Clinically node-positive (cN+) urothelial carcinoma of the bladder treated with chemotherapy and radical cystectomy: Clinical outcomes and development of a postoperative risk stratification model.

Urol Oncol. 2020-3

[9]
A Randomized Trial of Lymphadenectomy in Patients with Advanced Ovarian Neoplasms.

N Engl J Med. 2019-2-28

[10]
Effectiveness of extended pelvic lymphadenectomy in the survival of prostate cancer: a systematic review and meta-analysis.

Cent European J Urol. 2018

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