Extended vs non-extended pelvic lymph node dissection and their influence on recurrence-free survival in patients undergoing radical cystectomy for bladder cancer: a systematic review and meta-analysis of comparative studies
Extended vs non-extended pelvic lymph node dissection and their influence on recurrence-free survival in patients undergoing radical cystectomy for bladder cancer: a systematic review and meta-analysis of comparative studies
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扩大与非扩大盆腔淋巴结清扫及其对接受膀胱癌根治性膀胱切除术的患者无复发生存的影响：比较研究的系统评价和荟萃分析
DOI：
10.1111/bju.12371
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发表时间：
2014-05-01
影响因子：
4.5
通讯作者：
Huang, Jian
中科院分区：
文献类型：
--
作者：
Bi, Liangkuan;Huang, Hai;Huang, Jian
目的比较扩大盆腔淋巴结清扫术（ePLND）与非扩大盆腔淋巴结清扫术（non-extended pelvic lymph node dissection，NHL）的优缺点（非ePLND），并评估它们对接受根治性膀胱切除术的膀胱癌患者的无复发生存期（RFS）的影响。我们对所有评估盆腔淋巴结清扫（PLND）范围的比较研究进行了系统回顾和累积荟萃分析。结果6项研究共纳入2824例患者，总体分析显示，接受ePLND的患者的RFS率显著高于未接受ePLND的患者亚组分析发现，与非ePLND相比，ePLND与淋巴结阴性患者（HR：0.68; P = 0.007）和淋巴结阳性患者（HR：0.58; P < 0.001）的更好RFS率相关。当按病理T分期分层时，ePLND为pT 3 -4疾病患者提供了额外的RFS益处（HR：0.61; P < 0.001），但对pT 3 -4疾病患者则没有。
ObjectiveTo compare extended pelvic lymph node dissection (ePLND) with non-extended pelvic lymph node dissection (non-ePLND) and assess their influence on recurrence-free survival (RFS) in patients undergoing radical cystectomy for bladder cancer.MethodsThrough a comprehensive search of the PubMed, Embase and Cochrane Library databases in September 2012, we performed a systematic review and cumulative meta-analysis of all comparative studies assessing the extent of pelvic lymph node dissection (PLND) and its influence on RFS.ResultsSix studies with a total of 2824 patients were identified.Overall analysis showed a significantly better RFS rate in patients who had undergone ePLND than in those who had undergone non-ePLND (hazard ratio [HR]: 0.65; P < 0.001).A subgroup analysis found that, compared with non-ePLND, ePLND was associated with a better RFS rate for both patients with negative lymph nodes (HR: 0.68; P = 0.007) and those with positive lymph nodes (HR: 0.58; P < 0.001). When stratified by pathological T stage, ePLND provided additional RFS benefits for patients with pT3-4 disease (HR: 0.61; P < 0.001), but not for patients with