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目的评价系统性盆腔及腹主动脉旁淋巴结清扫术对晚期卵巢上皮性恶性肿瘤预后的影响。方法计算机检索PUBMED数据库,试验组为晚期卵巢上皮性恶性肿瘤行满意肿瘤细胞减灭术+系统性盆腔及腹主动脉旁淋巴结清扫术,对照组仅行满意肿瘤细胞减灭术,术后均行规范化疗。采用RevMan4.2软件进行meta分析。以患者的生存率、围手术期并发症发生率为疗效观察指标,合并RR值比较清扫组与未清扫组的三年总生存率(OS)、5年总生存率、围手术期并发症发生率。结果共有5个临床试验包括899例病人符合纳入标准。结果显示,在满意的肿瘤细胞减灭术下淋巴结清扫组较未清扫组:(1)3年OS无显著性差异(RR=1.06,95%CI:0.94～1.20,p=0.35);(2)5年OS无显著性差异(RR=1.17,95%CI:0.98～1.39,p=0.08);(3)清扫组围手术期并发症发生率远较对照组高(RR=1.58,95%CI:1.15～2.18,p=0.005),差异有统计学意义。结论在理想肿瘤细胞减灭术下,系统性盆腔及腹主动脉旁淋巴结清扫术不能改善患者的3年OS,亦不能提高其5年OS。而围手术期并发症发生率显著提高,尽管主要归因于淋巴囊肿的形成。
Objective To evaluate the effect of systemic pelvic and para-aortic lymph node dissection on the prognosis of patients with advanced epithelial ovarian cancer. Methods The PUBMED database was searched by computer. The experimental group was satisfied with tumor cytoreduction + systemic pelvic and para-aortic lymph node dissection in advanced ovarian epithelial malignancies. The control group was only satisfied with tumor cytoreductive surgery, Regulate chemotherapy. RevMan4.2 software for meta-analysis. Survival rate and perioperative complication rate of patients were used as efficacy indicators. The combined RR was compared between the three-year overall survival (OS), 5-year overall survival and perioperative complications rate. Results A total of 5 clinical trials including 899 patients met the inclusion criteria. The results showed that there was no significant difference in the 3-year OS (RR = 1.06, 95% CI: 0.94-1.20, p = 0.35); (2) (RR = 1.17, 95% CI: 0.98-1.39, p = 0.08); (3) The incidence of perioperative complications in the treatment group was significantly higher than that in the control group (RR = 1.58, 95% CI: 1.15 ~ 2.18, p = 0.005), the difference was statistically significant. Conclusions Under ideal cytoreductive surgery, systemic pelvic and paraaortic lymphadenectomy does not improve patients’ 3-year OS, nor does it improve their 5-year OS. The incidence of perioperative complications was significantly increased, although mainly due to the formation of lymphatic cysts.