摘要
目的系统评价中国肝内胆管癌(ICC)患者手术治疗淋巴结清扫概况。方法以"肝内胆管癌/intrahepatic cholangiocarcinoma""肝内胆管细胞癌/intrahepatic cholangiocellular carcinoma""淋巴结清扫/lymph node dissection""淋巴结切除/lymphadenectomy""淋巴结转移/lymph node metastasis"为关键词,系统检索中国知网、万方、维普、Sinomed、PubMed、Embase、Web of Science、Scopus、Cochrane Library数据库。检索时间为建库至2022年4月20日,获取记录了术中淋巴结清扫情况的且研究目的为分析ICC患者临床病理特征或预后影响因素的队列研究或随机对照临床试验。非随机对照试验的偏倚风险采用纽卡斯尔-渥太华量表进行评价。使用R软件对中国ICC患者的术前影像学淋巴结肿大率、淋巴结清扫率、病理淋巴结阳性率进行荟萃分析。结果纳入符合系统评价标准的相关研究33篇,均为回顾性队列研究。33篇文献均为中、高质量文献。患者入组时间范围为1993~2020年。病例来源于20个省/自治区/直辖市,共39个医疗中心,共计4278例ICC患者。荟萃分析结果显示,淋巴结清扫率为47.8%(95%CI:41.3%~54.3%),术前影像学检查提示淋巴结肿大率为18.5%(95%CI:7.5%~29.6%),病理淋巴结阳性率为51.2%(95%CI:43.8%~58.6%)。亚组分析结果显示,入组中位年份在2010年前的研究中淋巴结清扫率为36.0%(95%CI:27.0%~45.0%),2010~2017年研究中的淋巴结清扫率为48.3%(95%CI:38.1%~58.6%),2017年后研究中的淋巴结清扫率为53.3%(95%CI:43.3%~63.2%),淋巴结清扫率在不同入组年份的研究中差异有统计学意义(P=0.032)。结论中国ICC患者手术治疗的总体淋巴结清扫水平仍不高,但淋巴结清扫率随时间推移呈现出上升的趋势。
Objective To systematically review the profile of lymph node dissection(LND)for patients with intrahepatic cholangiocarcinoma(ICC)in China.Methods Using the key words"intrahepatic cholangiocarcinoma""intrahepatic cholangiocellular carcinoma""lymph node dissection""lymphadenec-tomy""lymph node metastasis",the databases including China Zhiwang,Wanfang,Weipu,Sinomed,PubMed,Embase,Web of Science,Scopus,Cochrane Library were systematically searched.Cohort studies or randomized controlled clinical trials with intraoperative LND documentation and with analysis on the clinicopathologic characteristics or prognostic influences on patients with ICC were included into this meta-analysis from the date of database creation to April 20,2022.The risk of bias in non-randomized controlled trials was evaluated using the Newcastle-Ottawa scale.A meta-analysis of preoperative imaging lymph node enlargement rates,LND rates,and pathological lymph node metastasis rates were performed using R software.Results Thirty-three relevant studies that met the systematic evaluation criteria were included,all of which were retrospective cohort studies.All these publications were of medium to high quality.Patients’enrollment ranged from 1993 to 2020.Patients were enrolled from 20 provinces/autonomous regions/municipalities with a total of 39 medical centers and 4278 patients.The meta-analysis indicated that the LND rate,preoperative imaging lymph node enlargement rate,pathological lymph node metastasis rate were 47.8%(95%CI:41.3%-54.3%),18.5%(95%CI:7.5%-29.6%)and 51.2%(95%CI:43.8%-58.6%),respectively.Subgroup analysis showed the LND rate was 36.0%(95%CI:27.0%-45.0%)in studies with a median year of enrollment before 2010,48.3%(95%CI:38.1%-58.6%)in studies from 2010 to 2017,and 53.3%(95%CI:43.3%-63.2%)in studies after 2017.The LND rates were statistically different in the studies in the different periods of patient enrollment(P=0.032).Conclusion The meta-analysis indicated that the overall LND rate for ICC in China was not high but showed an increasing tendency.
作者
李康德
蔡奇
林伟鸿
杨均兴
余勇
王振龙
彭观景
陈德雄
秦春宏
何涛
罗晓峰
林谦益
Li Kangde;Cai Qi;Lin Weihong;Yang Junxing;Yu Yong;Wang Zhenlong;Peng Guanjing;Chen Dexiong;Qin Chunhong;He Tao;Luo Xiaofeng;Lin Qianyi(Department of Liver Surgery,Zhanjiang Central Hospital,Guangdong Medical University,Zhanjiang 524000,China;Department of Pancreaticobiliary and Splenic Surgery,Zhanjiang Central Hospital,Guangdong Medical University,Zhanjiang 524000,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2023年第4期292-298,共7页
Chinese Journal of Hepatobiliary Surgery
关键词
胆管上皮癌
淋巴结清扫
淋巴结转移
荟萃分析
Cholangiocarcinoma
Lymph node dissection
Lymph node metastasis
Meta-analysis
作者简介
通信作者:林谦益,Email:qianyi.lin@foxmail.com;李康德,对本文有同等贡献;蔡奇,对本文有同等贡献。
