纵隔淋巴结切除方式对非小细胞肺癌患者术后生存的影响——4个相关研究的Meta分析

目的 用Meta分析(meta-analysis)的方法对国内外已发表的高质量的有关比较纵隔淋巴结清扫术和采样术对非小细胞肺癌患者术后生存期影响的临床研究进行综合定量分析。为非小细胞肺癌外科治疗中纵隔淋巴结处理模式的选择提供参考依据。材料与方法收集已公开发表的有关比较肺叶(全肺)切除加纵隔淋巴结清扫术和肺叶(全肺)切除加纵隔淋巴结采样术对非小细胞肺癌患者术后生存期影响的所有随访严密的临床研究,按Meta分析的要求对检索到的原始研究的质量进行评估,对符合条件的所有研究结果进行Meta分析,计算纵隔淋巴结清扫组相对采样组死亡危险的优势比(odds ratio,OR)评价纵隔淋巴清扫术和采样术对患者生存期的影响。结果符合纳入标准的共4篇文献,总样本量977例。其中纵隔淋巴结清扫组48l例,死亡194例;纵隔淋巴结采样组496例,死亡247例;合并OR=0．67,95％可信区间是(0．52-0．87)。结论 与肺叶(全肺)切除加纵隔淋巴结采样术相比,肺叶(全肺)切除加纵隔淋巴结清扫术可以延长患者的生存期,降低0．33的死亡危险。

Effectiveness of extent of lymphadenectomy for survival in patients with resectable non-small cell lung cancer--a meta-analysis for 4 relative studies

Objective: Search all studies that have been published in the world with regard to the effectiveness of the extent of lymphadenectomy for survival in patients with resectable non-small cell lung cancer and analyze them which are in high quality by means of meta-analysis, in order to give some evidences for the choice of method dealing with mediastinal lymph node in surgery. Material and Method: Evaluate strictly all the studies that have been searched and adopt the studies in high quality that can be analyzed by means of meta-analysis. Calculate the odds ratio (OR) for death during the time to follow-up between the patients with systematic mediastinal lymph node dissection and the patients with mediastinal lymph node sampling. Evaluate the effectiveness of the extent of lymphadenectomy for survival in patients with resectable non-small cell lung cancer. RevMan4. 1 software was applied to process data. Result: Totally 4 studies including 997 cases were analyzed. The cumulative cases in systematic lymph node dissection group were 481, in which 194 cases were dead; while in lymph node sampling group were 496 and 247 respectively. The pooled OR was 0. 67, with a 95% confidence interval (0. 52 - 0. 87). Conclusion: Systematic mediastinal lymph node dissection can give some benefit for survival to patients with resectable non-small cell lung cancer. The overall OR for death was decreased 0. 33 in patients with mediastinal lymph node dissection compared with mediastinal lymph node sampling.