Background: Para-aortic lymphadenectomy can be used for both diagnostic and therapeutic purposes as it aids in staging, provides prognostic data, and influences the patient’s options for adjuvant therapy. However, there is still contention over its potential in treating cancer. A systematic review of the literature was performed to look into the published randomized controlled studies (RCTs) that have reported the effectiveness of lymphadenectomy. Methods: Five different electronic databases, including PubMed, Cochrane Library, Clinical trials.gov, ICTRP, and Embase, were used to conduct a comprehensive search. Original RCTs reporting on the impact of lymphadenectomy on the overall survival in various cancers were included. Information related to the study population, intervention, type of cancer, primary endpoints, and key findings of the study were extracted. Quality assessment of the selected studies was conducted using the Revised Cochrane Risk of Bias Tool Rob 2 for randomized trials. Results: A total of 1693 citations, with 1511 from PubMed, 80 from the Cochrane Library, 67 from Embase, 18 from ICTRP, and 17 from Clinicaltrials.gov were retrieved. Preliminary screening was performed, and after applying selection criteria, nine articles were included in the final qualitative analysis. The total number of patients was 4231, and the sample size ranged from 70 to 1408. Among these nine studies, four studies were on genital cancers (two ovarian cancers, one endometrial cancer, and one cervical cancer); four on digestive cancers (advanced gastric cancers); and one on urinary cancer (advanced bladder cancer). These studies reported that para-aortic lymphadenectomy did not improve overall survival and disease-free survival in advanced ovarian cancers, early endometrial cancers, advanced gastric, and bladder cancers. All of the studies had a low risk of bias. Conclusions: Para-aortic lymphadenectomy is not advised in advanced ovarian cancers, early endometrial cancers with low risks, advanced gastric cancers, and bladder cancers. SNB could be an alternative to lymphadenectomy for ovarian cancer in the future. Clinicians should inform patients regarding the benefits of para-aortic lymphadenectomy in terms of survival and the potential risks associated with it.
背景：主动脉旁淋巴结清扫术兼具诊断与治疗双重目的，既可辅助肿瘤分期、提供预后信息，又能影响患者辅助治疗方案的选择。然而，其在癌症治疗中的实际价值仍存争议。本研究通过系统性文献回顾，对已发表的评估淋巴结清扫术疗效的随机对照试验（RCT）进行综合分析。 方法：系统检索PubMed、Cochrane Library、Clinicaltrials.gov、ICTRP及Embase五大电子数据库，纳入报道淋巴结清扫术对不同癌症总生存期影响的原始RCT研究。提取数据包括研究人群特征、干预措施、癌症类型、主要终点指标及关键研究结果。采用修订版Cochrane偏倚风险评估工具（ROB 2）对纳入研究进行质量评价。 结果：共检索到1693篇文献（PubMed 1511篇、Cochrane Library 80篇、Embase 67篇、ICTRP 18篇、Clinicaltrials.gov 17篇）。经初步筛选并应用选择标准后，最终9篇文献纳入定性分析。研究总样本量4231例，单篇样本量70-1408例不等。9项研究中，4项针对生殖系统肿瘤（卵巢癌2项、子宫内膜癌1项、宫颈癌1项），4项针对消化系统肿瘤（进展期胃癌），1项针对泌尿系统肿瘤（进展期膀胱癌）。综合分析显示，主动脉旁淋巴结清扫术未能改善进展期卵巢癌、早期子宫内膜癌、进展期胃癌及膀胱癌患者的总生存期与无病生存期。所有纳入研究的偏倚风险均为低等级。 结论：对于进展期卵巢癌、低危早期子宫内膜癌、进展期胃癌及膀胱癌，不建议常规实施主动脉旁淋巴结清扫术。前哨淋巴结活检未来可能成为卵巢癌淋巴结清扫的替代方案。临床医生应向患者充分说明主动脉旁淋巴结清扫术的生存获益潜力及相关手术风险。
肿瘤(癌症)患者之家