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目的评价系统性腹膜后淋巴结切除(systematic lymphadenectomy,SL)与非系统性腹膜后淋巴结切除(unsystematic lymphadenectomy,USL)治疗上皮性卵巢癌(EOC)的有效性。方法计算机检索PubMed、EMbase、Cochrane Library、循证医学数据库(Evidence-Based Medicine Reviews,EBMR)、中国生物医学文献数据库、中国期刊全文数据库和中文科技期刊全文数据库等,检索时限为1995年1月1日至2010年12月31日,纳入SL与USL比较治疗上皮性卵巢癌的随机对照试验(RCT)或观察性研究。采用Cochrane系统评价方法对纳入研究进行资料提取和方法学质量评价后,用RevMan 5.0软件进行Meta分析。结果共纳入13个研究,22 796例患者,其中SL组5?420例,USL组17?376例。13个纳入研究中,2个为RCT,11个为观察性研究(其中2个数据来自美国国立癌症中心的SEER数据库)。2个RCT的结果显示,与USL相比:①SL不能改善早期(FIGOⅠ～Ⅱ)上皮性卵巢癌患者的5年无进展生存率(5-PFS)[OR=0.70,95%CI(0.40,1.22),P=0.21],但能改善晚期(FIGOⅢ～Ⅳ)上皮性卵巢癌患者的5-PFS[OR=0.62,95%CI(0.40,0.96),P=0.03];②SL不能改善早期[OR=0.84,95%C(I0.44,1.58),P=0.58]及晚期[OR=0.93,95%C(I0.64,1.37),P=0.73]上皮性卵巢癌患者的5年总生存率(5-OS);③SL也不能改善达到理想减瘤的早期[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。观察性研究的合并分析结果显示,与USL相比:①SL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不论是否除外SEER的影响,SL均能改善早期[OR=0.54,95%C(I0.46,0.63),P<0.00001;OR=0.59,95%C(I0.38,0.92),P<0.02]及晚期[OR=0.47,95%CI(0.43,0.52),P<0.000?01;OR=0.57,95%CI(0.42,0.77),P=0.0002]上皮性卵巢癌患者的5-OS;③SL不能改善达到理想减瘤的早期患者的5-OS[OR=0.32,95%CI(0.02,6.19),P=0.45],但能改善达到理想减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]。结论 SL有可能改善上皮性卵巢癌的5-PFS及5-OS。但由于缺乏足够的RCT,SL对上皮性卵巢癌5-PFS及5-OS的影响仍不确定,需要开展更多RCT进一步明确。
Objective To evaluate the efficacy of systemic lymphadenectomy (SL) and unsystematic lymphadenectomy (USL) in the treatment of epithelial ovarian cancer (EOC). Methods PubMed, EMbase, Cochrane Library, Evidence-Based Medicine Reviews (EBMR), China Biomedical Literature Database, Chinese Journal Full-text Database and Chinese Science and Technology Journal Full-text Database were searched by computer. The search time was January 1, 1995 As of December 31, 2010, a randomized controlled trial (RCT) or observational study comparing SL to USL for the treatment of epithelial ovarian cancer was included. The Cochrane review was used to perform meta-analysis using RevMan 5.0 software after data extraction and methodological quality evaluation of the included studies. Results A total of 13 studies were enrolled in 22 796 patients, of whom 5? 420 in the SL group and 17? 376 in the USL group. Thirteen were included in the study, two were RCTs and 11 were observational studies (two of which were from the SEER database of the National Cancer Center). The results of 2 RCTs showed that compared with the USL, ①SL could not improve the 5-year progression-free survival rate (OR = 0.70, 95% CI 0.40, 1.22, P <0.05) of patients with FIGOⅠ ~ Ⅱ epithelial ovarian cancer ), P = 0.21], but improved 5-PFS in patients with FIGO Ⅲ ~ Ⅳ epithelial ovarian cancer [OR = 0.62,95% CI (0.40,0.96), P = 0.03] = 0.84, 95% C (I0.44, 1.58), P = 0.58] and advanced [OR = 0.93,95% C (I0.64,1.37), P = 0.73] 5-year overall survival in patients with epithelial ovarian cancer (OR = 0.84, 95% CI (0.44, 1.58), P = 0.58], and advanced [OR = 0.93, 95% CI (0.64, 1.37) , P = 0.73] 5-OS in epithelial ovarian cancer patients. The results of the combined analysis of observational studies showed that compared with the USL, SL did not improve early (OR = 0.38, 95% CI, 0.08, 1.74, P = 0.21) and late (OR = 2.88, 95% CI ), P = 0.06], 5-PFS in patients with epithelial ovarian cancer; (2) SL improved early with or without the influence of SEER [OR = 0.54,95% C (I0.46,0.63, P <0.00001; = 0.59, 95% C (I0.38, 0.92), P <0.02], and late [OR = 0.47,95% CI (0.43,0.52), P <0.0001; OR = 0.57,95% CI 0.77), P = 0.0002], 5-OS in patients with epithelial ovarian cancer; (3) SL did not improve 5-OS in early stage patients with ideal tumorigenicity [OR = 0.32, 95% CI But improved 5-OS in patients with advanced epithelial ovarian cancer [OR = 0.53, 95% CI (0.32, 0.88), P = .01] that achieved optimal tumorigenicity. Conclusion SL may improve 5-PFS and 5-OS of epithelial ovarian cancer. However, due to the lack of sufficient RCT, the effect of SL on 5-PFS and 5-OS of epithelial ovarian cancer remains uncertain and more RCTs need further clarification.