系統性腹膜后淋巴結清掃對上皮性卵巢癌患者預后影響的Meta分析_《中國循證醫學雜志》

作者：

覃金春 , 陽志軍 , 熊黎 ,  李力

廣西醫科大學附屬腫瘤醫院婦瘤科（南寧 530021）;

關鍵詞：

上皮性卵巢癌系統性淋巴結清掃非系統性淋巴結清掃 Meta分析系統評價隨機對照試驗觀察性研究

DOI：

10.7507/1672-2531.20120036

視頻：

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目的　評價系統性腹膜后淋巴結切除（systematic lymphadenectomy，SL）與非系統性腹膜后淋巴結切除（unsystematic lymphadenectomy，USL）治療上皮性卵巢癌（EOC）的有效性。
方法　計算機檢索PubMed、EMbase、Cochrane Library、循證醫學數據庫（Evidence-Based Medicine Reviews，EBMR）、中國生物醫學文獻數據庫、中國期刊全文數據庫和中文科技期刊全文數據庫等，檢索時限為1995年1月1日至2010年12月31日，納入SL與USL比較治療上皮性卵巢癌的隨機對照試驗（RCT）或觀察性研究。采用Cochrane系統評價方法對納入研究進行資料提取和方法學質量評價后，用RevMan 5.0軟件進行Meta分析。
結果　共納入13個研究，22 796例患者，其中SL組5 420例，USL組17 376例。13個納入研究中，2個為RCT，11個為觀察性研究（其中2個數據來自美國國立癌癥中心的SEER數據庫）。2個RCT的結果顯示，與USL相比：① SL不能改善早期（FIGO Ⅰ～Ⅱ）上皮性卵巢癌患者的5年無進展生存率（5-PFS）［OR=0.70，95%CI（0.40，1.22），P=0.21］，但能改善晚期（FIGO Ⅲ～Ⅳ）上皮性卵巢癌患者的5-PFS［OR=0.62，95%CI（0.40，0.96），P=0.03］；② SL不能改善早期［OR=0.84，95%CI（0.44，1.58），P=0.58］及晚期［OR=0.93，95%CI（0.64，1.37），P=0.73］上皮性卵巢癌患者的5年總生存率（5-OS）；③ SL也不能改善達到理想減瘤的早期［OR=0.84，95%CI（0.44，1.58），P=0.58］及晚期［OR=0.93，95%CI（0.64，1.37），P=0.73］上皮性卵巢癌患者的5-OS。觀察性研究的合并分析結果顯示，與USL相比：① SL不能改善早期［OR=0.38，95%CI（0.08，1.74），P=0.21］及晚期［OR=2.88，95%CI（0.95，8.72），P=0.06］上皮性卵巢癌患者的5-PFS；② 不論是否除外SEER的影響，SL均能改善早期［OR=0.54，95%CI（0.46，0.63），P lt;0.000 01；OR=0.59，95%CI（0.38，0.92），P lt;0.02］及晚期［OR=0.47，95%CI（0.43，0.52），P lt;0.000 01；OR=0.57，95%CI（0.42，0.77），P=0.000 2］上皮性卵巢癌患者的5-OS；③ SL不能改善達到理想減瘤的早期患者的5-OS［OR=0.32，95%CI（0.02，6.19），P=0.45］，但能改善達到理想減瘤的晚期上皮性卵巢癌患者的5-OS［OR=0.53，95%CI（0.32，0.88），P=0.01］。
結論　SL有可能改善上皮性卵巢癌的5-PFS及5-OS。但由于缺乏足夠的RCT，SL對上皮性卵巢癌5-PFS及5-OS的影響仍不確定，需要開展更多RCT進一步明確。

引用本文： 覃金春,陽志軍,熊黎,李力. 系統性腹膜后淋巴結清掃對上皮性卵巢癌患者預后影響的Meta分析. 中國循證醫學雜志, 2012, 12(2): 224-230. doi: 10.7507/1672-2531.20120036 復制

1.	曹澤毅. 中華婦產科學. 北京: 人民衛生出版社, 2004: 2154.
2.	Chan JK, Cheung MK, HusainA, et al. Patterns and progress in ovarian cancer over 14 years. Obstet Gynecol, 2006, 108(3 Pt 1): 521-528.
3.	Pereira A, Magrina JF, Rey V, et al. Pelvic and aortic lymph node metastasis in epithelial ovarian cancer. Gynecol Oncol, 2007, 105(3): 604-608.
4.	Onda T, Yoshikawa H, Yokota H, et al. Assessment of metastases to aortic and pelvic lymph nodes in epithelial ovarian carcinoma. A proposal for essential sites for lymph node biopsy. Cancer, 1996, 78(4): 803-808.
5.	Chan JK, Urban R, Hu JM, et al. The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13918 patients. Br J Cancer, 2007, 96(12): 1817-1822.
6.	Chan JK, Munro EG, Cheung MK, et al. Association of lymphadenectomy and survival in stage I ovarian cancer patients. Obstet Gynecol, 2007, 109(1): 12-19.
7.	Maggioni A, Benedetti Panici P, Dell’Anna T, et al. Randomized study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis. Br J Cancer, 2006, 95(6): 699-704.
8.	Panici PB, Maggioni A, Hacker N, et al. Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimally debulked advanced ovarian cancer: a randomized clinical trial. J Natl Cancer Inst, 2005, 97(8): 560-566.
9.	Cohen J. A coefficient of agreement for nominal scales. Ednc Psychol Measure, 1960, 20(1): 37-46.
10.	Allen DG, Coulter J. Survival of patients with epithelial ovarian cancer and the effect of lymphadenectomy in those with stage Ⅲ disease. Aust N Z J Obstet Gynaecol, 1999, 39(4): 420-424.
11.	王榮業. 腹膜后淋巴結清除在卵巢上皮癌治療中的地位. 中國腫瘤臨床, 2001, 28(3): 192-194.
12.	Saygili U, Guclu S, Uslu T, et al. Does systematic lymphadenectomy have a benefit on survival of suboptimally debulked patients with stage III ovarian carcinoma? A DEGOG* Study. J Surg Oncol, 2002, 81(3): 132-137.
13.	熊宙芳, 王澤華, 王世宣. 卵巢上皮性癌的腹膜后淋巴結切除對預后的影響. 中華婦產科雜志, 2003, 38(2): 77-80.
14.	郄明蓉, 楊小蕓, 鄭艾, 等. 盆腔及腹主動脈旁淋巴結清掃術與卵巢上皮性癌OS分析. 四川大學學報, 2004, 35(3): 449-450.
15.	Isonishi S, Niimi S, Sasaki H, et al. Drug sensitivity-related benefit of systematic lymphadenectomy during cytoreductive surgery in optimally debulked stages IIIc and IV ovarian cancer. Gynecol Oncol, 2004, 93(3): 647-652.
16.	余冬青, 李力. 腹膜后淋巴結清掃在卵巢上皮癌治療中的作用. 廣東醫學, 2007, 28(9): 1489-1491.
17.	Suzuki S, Kajiyama H, Shibata K, et al. Is there any association between retroperitoneal lymphadenectomy and survival benefit in ovarian clear cell carcinoma patients? Ann Oncol, 2008, 19(7): 1284-1287.
18.	Abe A, Furumoto H, Irahara M, et al. The impact of systematic para-aortic and pelvic lymphadenectomy on survival in patients with optimally debulked ovarian cancer. J Obstet Gynaecol Res, 2010, 36(5): 1023-1030.
19.	Kim HS, Ju W, Jee BC, et al. Systematic lymphadenectomy for survival in epithelial ovarian cancer: a meta-analysis. Int J Gynecol Cancer, 2010, 20(4): 520-528.
20.	Baek SJ, Park JY, Kim DY, et al. Stage IIIC epithelial ovarian cancer classified solely by lymph node metastasis has a more favorable prognosis than other types of stage IIIC epithelial ovarian cancer. J Gynecol Oncol, 2008, 19(4): 223-228.
21.	Onda T, Yoshikawa H, Yokota H, et al. Assessment of metastases to aortic and pelvic lymph nodes in epithelial ovarian carcinoma. A proposal for essential sites for lymph node biopsy. Cancer, 1996, 78(4): 803-808.
22.	Soper JT, Johnson P, Johnson V, et al. Comprehensive restaging laparotomy in women with apparent early ovarian carcinoma. Obstet Gynecol, 1992, 80(6): 949-953.
23.	Cliby WA, Aletti GD, Wilson TO, et al. Is it justified to classify patients to Stage IIIC epithelial ovarian cancer based on nodal involvement only? Gynecol Oncol, 2006, 103(3): 797-801.
24.	Eisenkop SM, Spirtos NM. The clinical significance of occult macroscopically positive retroperitoneal nodes in patients with epithelial ovarian cancer. Gynecol Oncol, 2001, 82(1): 143-149.

1. 曹澤毅. 中華婦產科學. 北京: 人民衛生出版社, 2004: 2154.
2. Chan JK, Cheung MK, HusainA, et al. Patterns and progress in ovarian cancer over 14 years. Obstet Gynecol, 2006, 108(3 Pt 1): 521-528.
3. Pereira A, Magrina JF, Rey V, et al. Pelvic and aortic lymph node metastasis in epithelial ovarian cancer. Gynecol Oncol, 2007, 105(3): 604-608.
4. Onda T, Yoshikawa H, Yokota H, et al. Assessment of metastases to aortic and pelvic lymph nodes in epithelial ovarian carcinoma. A proposal for essential sites for lymph node biopsy. Cancer, 1996, 78(4): 803-808.
5. Chan JK, Urban R, Hu JM, et al. The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13918 patients. Br J Cancer, 2007, 96(12): 1817-1822.
6. Chan JK, Munro EG, Cheung MK, et al. Association of lymphadenectomy and survival in stage I ovarian cancer patients. Obstet Gynecol, 2007, 109(1): 12-19.
7. Maggioni A, Benedetti Panici P, Dell’Anna T, et al. Randomized study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis. Br J Cancer, 2006, 95(6): 699-704.
8. Panici PB, Maggioni A, Hacker N, et al. Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimally debulked advanced ovarian cancer: a randomized clinical trial. J Natl Cancer Inst, 2005, 97(8): 560-566.
9. Cohen J. A coefficient of agreement for nominal scales. Ednc Psychol Measure, 1960, 20(1): 37-46.
10. Allen DG, Coulter J. Survival of patients with epithelial ovarian cancer and the effect of lymphadenectomy in those with stage Ⅲ disease. Aust N Z J Obstet Gynaecol, 1999, 39(4): 420-424.
11. 王榮業. 腹膜后淋巴結清除在卵巢上皮癌治療中的地位. 中國腫瘤臨床, 2001, 28(3): 192-194.
12. Saygili U, Guclu S, Uslu T, et al. Does systematic lymphadenectomy have a benefit on survival of suboptimally debulked patients with stage III ovarian carcinoma? A DEGOG* Study. J Surg Oncol, 2002, 81(3): 132-137.
13. 熊宙芳, 王澤華, 王世宣. 卵巢上皮性癌的腹膜后淋巴結切除對預后的影響. 中華婦產科雜志, 2003, 38(2): 77-80.
14. 郄明蓉, 楊小蕓, 鄭艾, 等. 盆腔及腹主動脈旁淋巴結清掃術與卵巢上皮性癌OS分析. 四川大學學報, 2004, 35(3): 449-450.
15. Isonishi S, Niimi S, Sasaki H, et al. Drug sensitivity-related benefit of systematic lymphadenectomy during cytoreductive surgery in optimally debulked stages IIIc and IV ovarian cancer. Gynecol Oncol, 2004, 93(3): 647-652.
16. 余冬青, 李力. 腹膜后淋巴結清掃在卵巢上皮癌治療中的作用. 廣東醫學, 2007, 28(9): 1489-1491.
17. Suzuki S, Kajiyama H, Shibata K, et al. Is there any association between retroperitoneal lymphadenectomy and survival benefit in ovarian clear cell carcinoma patients? Ann Oncol, 2008, 19(7): 1284-1287.
18. Abe A, Furumoto H, Irahara M, et al. The impact of systematic para-aortic and pelvic lymphadenectomy on survival in patients with optimally debulked ovarian cancer. J Obstet Gynaecol Res, 2010, 36(5): 1023-1030.
19. Kim HS, Ju W, Jee BC, et al. Systematic lymphadenectomy for survival in epithelial ovarian cancer: a meta-analysis. Int J Gynecol Cancer, 2010, 20(4): 520-528.
20. Baek SJ, Park JY, Kim DY, et al. Stage IIIC epithelial ovarian cancer classified solely by lymph node metastasis has a more favorable prognosis than other types of stage IIIC epithelial ovarian cancer. J Gynecol Oncol, 2008, 19(4): 223-228.
21. Onda T, Yoshikawa H, Yokota H, et al. Assessment of metastases to aortic and pelvic lymph nodes in epithelial ovarian carcinoma. A proposal for essential sites for lymph node biopsy. Cancer, 1996, 78(4): 803-808.
22. Soper JT, Johnson P, Johnson V, et al. Comprehensive restaging laparotomy in women with apparent early ovarian carcinoma. Obstet Gynecol, 1992, 80(6): 949-953.
23. Cliby WA, Aletti GD, Wilson TO, et al. Is it justified to classify patients to Stage IIIC epithelial ovarian cancer based on nodal involvement only? Gynecol Oncol, 2006, 103(3): 797-801.
24. Eisenkop SM, Spirtos NM. The clinical significance of occult macroscopically positive retroperitoneal nodes in patients with epithelial ovarian cancer. Gynecol Oncol, 2001, 82(1): 143-149.

《中國循證醫學雜志》

系統性腹膜后淋巴結清掃對上皮性卵巢癌患者預后影響的Meta分析

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《中國循證醫學雜志》

系統性腹膜后淋巴結清掃對上皮性卵巢癌患者預后影響的Meta分析

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