Lymph node density as a prognostic variable in node-positive bladder cancer: a meta-analysis.
Lymph node density as a prognostic variable in node-positive bladder cancer: a meta-analysis.
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DOI：
10.1186/s12885-015-1448-x
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发表时间：
2015-06-02
期刊：
影响因子：
3.8
通讯作者：
Kim HH
中科院分区：
文献类型：
--
作者：
Ku JH;Kang M;Kim HS;Jeong CW;Kwak C;Kim HH
虽然淋巴结（LN）状态和LN负担决定了膀胱癌患者接受cytokine治疗的结果，但将LN密度纳入当前分期系统的论点令人信服。在此，我们研究LN阳性患者行膀胱癌根治术后LN密度与临床结果的关系。检索PubMed、SCOPUS、科学信息研究所Web of Science和科克伦图书馆，以确定相关的已发表文献。荟萃分析纳入了14项研究，共计3311例患者。在这14篇文献中，6项研究（533例患者）、10项研究（2966例患者）和5项研究（1108例患者）分别研究了LN密度与无病生存期（DFS）、疾病特异性生存期（DSS）和总生存期（OS）的预后相关性。DFS的合并风险比（HR）为1.45（95%置信区间[CI]，1.10-1.91），无异质性（I2 = 0%，p = 0.52）。较高的LN密度与较差的DSS显著相关（合并HR，1.53; 95%CI，1.23-1.89）。然而，研究之间存在显著异质性（I2 = 66%，p = 0.002）。OS的汇总HR具有统计学显著性（汇总HR，1.45; 95% CI，1.11-1.90），无异质性（I2 = 42%，p = 0.14）。Begg和Egger检验的结果表明，在这项荟萃分析中，发表偏倚并不明显。这项荟萃分析的数据表明，LN密度是LN阳性患者临床结局的独立预测因子。LN密度可能是有用的，在未来的分期系统，从而使更好的预后分类LN阳性膀胱癌。本文的在线版本（doi：10.1186/s12885-015-1448-x）包含补充材料，可供授权用户使用。
Although lymph node (LN) status and the LN burden determine the outcome of bladder cancer patients treated with cystectomy, compelling arguments have been made for the incorporation of LN density into the current staging system. Here, we investigate the relationship between LN density and clinical outcome in patients with LN-positive disease, following radical cystectomy for bladder cancer. PubMed, SCOPUS, the Institute for Scientific Information Web of Science, and the Cochrane Library were searched to identify relevant published literature. Fourteen studies were included in the meta-analysis, with a total number of 3311 patients. Of these 14 publications, 6 studies, (533 patients), 10 studies (2966 patients), and 5 studies (1108 patients) investigated the prognostic association of LN density with disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS), respectively. The pooled hazard ratio (HR) for DFS was 1.45 (95 % confidence interval [CI], 1.10–1.91) without heterogeneity (I2 = 0 %, p = 0.52). Higher LN density was significantly associated with poor DSS (pooled HR, 1.53; 95 % CI, 1.23–1.89). However, significant heterogeneity was found between studies (I2 = 66 %, p = 0.002). The pooled HR for OS was statistically significant (pooled HR, 1.45; 95 % CI, 1.11–1.90) without heterogeneity (I2 = 42 %, p = 0.14). The results of the Begg and Egger tests suggested that publication bias was not evident in this meta-analysis. The data from this meta-analysis indicate that LN density is an independent predictor of clinical outcome in LN-positive patients. LN density may be useful in future staging systems, thus allowing better prognostic classification of LN-positive bladder cancer. The online version of this article (doi:10.1186/s12885-015-1448-x) contains supplementary material, which is available to authorized users.
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