文章：

胃癌根治术中D2淋巴结清扫的长期影响：个体患者数据荟萃分析与限制性平均生存时间评估

Long-Term Impact of D2 Lymphadenectomy during Gastrectomy for Cancer: Individual Patient Data Meta-Analysis and Restricted Mean Survival Time Estimation

原文发布日期：19 January 2024

DOI: 10.3390/cancers16020424

类型: Article

开放获取: 是

英文摘要：

Background: Debate exists concerning the impact of D2 vs. D1 lymphadenectomy on long-term oncological outcomes after gastrectomy for cancer. Methods: PubMed, MEDLINE, Scopus, and Web of Science were searched and randomized controlled trials (RCTs) analyzing the effect of D2 vs. D1 on survival were included. Overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were assessed. Restricted mean survival time difference (RMSTD) and 95% confidence intervals (CI) were used as effect size measures. Results: Five RCTs (1653 patients) were included. Overall, 805 (48.7%) underwent D2 lymphadenectomy. The RMSTD OS analysis shows that at 60-month follow-up, D2 patients lived 1.8 months (95% CI −4.2, 0.7;p= 0.14) longer on average compared to D1 patients. Similarly, 60-month CSS (1.2 months, 95% CI −3.9, 5.7;p= 0.72) and DFS (0.8 months, 95% CI −1.7, 3.4;p= 0.53) tended to be improved for D2 vs. D1 lymphadenectomy. Conclusions: Compared to D1, D2 lymphadenectomy is associated with a clinical trend toward improved OS, CSS, and DFS at 60-month follow-up.

摘要翻译： 

背景：关于胃癌根治术中D2与D1淋巴结清扫对长期肿瘤学结局的影响仍存争议。方法：系统检索PubMed、MEDLINE、Scopus及Web of Science数据库，纳入分析D2与D1淋巴结清扫对生存影响的随机对照试验。评估指标包括总生存期、癌症特异性生存期和无病生存期。采用限制平均生存时间差及其95%置信区间作为效应量指标。结果：共纳入5项随机对照试验（1653例患者），其中805例（48.7%）接受D2淋巴结清扫。限制平均生存时间差分析显示：在60个月随访期，D2组患者平均总生存期较D1组延长1.8个月（95% CI -4.2, 0.7; p=0.14）。同样，D2组在60个月癌症特异性生存期（延长1.2个月，95% CI -3.9, 5.7; p=0.72）和无病生存期（延长0.8个月，95% CI -1.7, 3.4; p=0.53）方面均呈现改善趋势。结论：在60个月随访期，与D1淋巴结清扫相比，D2清扫在总生存期、癌症特异性生存期和无病生存期方面均显示出临床改善趋势。

原文链接：

Long-Term Impact of D2 Lymphadenectomy during Gastrectomy for Cancer: Individual Patient Data Meta-Analysis and Restricted Mean Survival Time Estimation