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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 155 -160. doi: 10.3877/cma.j.issn.1674-0793.2023.02.017

循证医学

淋巴结清扫对肝内胆管癌预后价值的Meta分析
周金龙1, 刘俊杰2, 谷昊1,†()   
  1. 1. 830011　乌鲁木齐，新疆医科大学第一附属医院肝脏腹腔镜外科
    2. 200438　上海，海军军医大学附属东方肝胆外科医院肝外四科
  • 收稿日期:2022-12-05 出版日期:2023-04-01
  • 通信作者: 谷昊

Prognostic value of lymph node dissection for intrahepatic cholangiocarcinoma: A meta-analysis

Jinlong Zhou1, Junjie Liu2, Hao Gu1,†()   

  1. 1. Department of Laparoscopic Surgery of the Liver, the First Affiliated Hospital of Xinjiang Medical University, Urumchi 830011, China
    2. The Fourth Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University, Shanghai 200438, China
  • Received:2022-12-05 Published:2023-04-01
  • Corresponding author: Hao Gu
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引用本文：

周金龙, 刘俊杰, 谷昊. 淋巴结清扫对肝内胆管癌预后价值的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(02): 155-160.

Jinlong Zhou, Junjie Liu, Hao Gu. Prognostic value of lymph node dissection for intrahepatic cholangiocarcinoma: A meta-analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(02): 155-160.

目的

评价淋巴结清扫（LND）对肝内胆管癌患者预后的影响。

方法

检索2012年1月至2022年10月间PubMed、EmBase、Web of Science、Cochrane、万方数据、中国知网数据库收录的文献，将肝内胆管癌手术治疗患者分为淋巴结清扫组（LND+组）及未行淋巴结清扫组（LND-组）。分析LND对患者预后的影响。

结果

共纳入21篇文献5 449例患者。LND并未改善患者总生存期（OS），清扫淋巴结阳性组（N1组）患者OS低于LND-组（HR=2.75，95% CI：1.73~4.36，P<0.05），清扫淋巴结阴性组（N0组）患者OS高于N1组患者（HR=0.35，95% CI：0.31~0.40，P<0.001），与LND-组患者OS差异无统计学意义。亚组分析结果提示，LND能显著提高R0切除亚组中患者的OS（HR=0.60，95% CI：0.44~0.81，P<0.01），但并不能改善临床淋巴结阴性亚组和非R0切除亚组患者的OS；R0切除亚组中，N0组患者OS高于LND-组（HR=0.75，95% CI：0.58~0.97，P<0.05）。LND+组并发症发生率显著高于LND-组（OR=1.88，95% CI：1.35~2.62，P<0.001），两组患者间术后复发率差异无统计学意义。

结论

LND使临床淋巴结阴性肝内胆管癌患者生存获益并不明显，但在不明确是否存在系统性转移的情况下，常规LND可能是更加保守的方式。

关键词: 肝内胆管癌, 淋巴结清扫, 预后, Meta分析
Objective

To investigate the prognostic value of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (ICC) patients.

Methods

From January 2012 to October 2022, the literature included in PubMed, EmBase, Web of Science, Cochrane, Wanfang Data, and CNKI database was retrieved. The literature required that the surgical intervention of ICC was divided into two groups: lymph node dissection (LND+ group) and non-lymph node dissection (LND-group) to analyze the effect of lymph node dissection on patient outcomes.

Results

A total of 5 449 patients from 21 studies were included, and the results of meta-analysis showed that LND did not improve the overall survival (OS). OS of patients in the N1 group was lower than that in the LND-group (HR=2.75, 95% CI: 1.73-4.36, P<0.05), and the OS of N0 group was higher than that of N1 group (HR=0.35, 95% CI: 0.31-0.40, P<0.001), which was not significantly different from the LND-group. Subgroup analysis showed that LND significantly increased OS of the R0 resection subgroup (HR=0.60, 95% CI: 0.44-0.81, P<0.01), but did not improve OS of the clinically lymph node metastasis subgroup and non-R0 resection subgroup, and the OS of patients in the N0 group was higher than that in the LND-group (HR=0.75, 95% CI: 0.58-0.97, P<0.05). The complication rate in the LND+ group was significantly higher than that in the LND-group (OR=1.88, 95% CI: 1.35-2.62, P<0.001). There was no statistically significant difference in postoperative recurrence rates between two groups.

Conclusion

The survival benefit of LND in patients with clinically node-negative ICC is not obvious, but routine LND may be a more conservative way when it is not clear whether systemic metastasis exists.

Key words: Intrahepatic cholangiocarcinoma, Lymph node dissection, Prognosis, Meta-analysis
图1 文献检索流程图
表1 纳入文献基本特征及质量评分
第一作者 发表年 国家 样本量(例) 性别(例) 淋巴结清扫(例) 多中心 匹配方式 中位随访时间(月) R0切除 质量评分
男 女 LND+ LND-
Chang[7] 2017 中国 103 54 49 36 67 否 无 - 非 6
Hu[8] 2017 中国 422 177 245 73 349 否 无 - 非 5
Miyata[9] 2017 日本 64 16 48 23 41 否 无 37 是 6
Xiao[10] 2017 中国 49 - - 35 14 否 无 - 非 5
Ke[12] 2021 中国 212 110 102 106 106 是 PSM - 是 8
Kim[13] 2015 韩国 215 138 77 113 102 否 无 - 非 6
Wu[14] 2015 中国 85 66 19 50 35 否 无 - 是 4
Li[15] 2013 中国 114 - - 53 61 否 无 - 是 6
Kim[16] 2019 韩国 68 38 30 34 34 否 PSM 65 是 7
Hu[17] 2021 美国 2 037 976 1 061 859 859 是 PSM 23 非 8
Yoh[18] 2019 法国、日本 112 63 49 56 56 是 PSM 28 非 8
Umeda[19] 2022 日本 310 181 129 224 86 是 IPTW 26 是 8
Vitale[20] 2016 美国 402 200 202 201 201 是 PSM - 非 8
高彪[21] 2021 中国 162 87 75 94 68 否 无 36 是 6
戴高凡[22] 2021 中国 81 35 46 39 42 否 无 35 是 6
季鸿翔[23] 2017 中国 154 100 54 77 77 否 PSM 34 是 7
王垒[24] 2020 中国 286 156 130 143 143 是 PSM - 是 8
谭志国[25] 2021 中国 135 64 71 72 63 否 无 32 是 5
黄徐建[26] 2020 中国 142 77 65 86 56 否 无 41 是 5
Choi[27] 2009 韩国 64 43 21 51 13 否 无 - 非 5
Hu[28] 2021 中国 232 127 105 177 55 是 IPTW 19 非 8
图2 淋巴结清扫对肝内胆管癌患者总生存期影响的Meta分析森林图
图3 淋巴结清扫对肝内胆管癌患者总生存期影响的亚组分析森林图
图4 清扫淋巴结阳性组和阴性组患者总生存期比较森林图
图5 清扫淋巴结阴性患者与未行淋巴结清扫患者R0切除亚组的总生存期比较森林图
图6 清扫淋巴结阳性患者与未行淋巴结清扫患者的总生存期比较森林图
图7 淋巴结清扫组与未行淋巴结清扫组患者术后复发率比较森林图
图8 淋巴结清扫组与未行淋巴结清扫组患者术后并发症发生率比较森林图
图9 肝内胆管癌患者的总生存期Meta分析漏斗图
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