肾部分切除术和肾癌根治术治疗T1b期肾癌疗效比较的Meta分析

发布时间：2018-11-23 13:26

【摘要】：目的：总结对侧肾功能正常的T1b期肾癌患者行肾部分切除术和根治性肾切除术的疗效差异，为临床上T1b期肾癌患者在手术方式的选择上提供循证学证据。方法：首先采用电子与手工检索对相关文献进行初检，进行电子检索的数据库有Pub med/Medlinedatabase、Cochrane图书馆、Embase、CNKI相关期刊论文、维普数据库和万方数字化期刊群，并通过各种主流搜索引擎查找与之相关文献。对所有文献进行严格的初步筛选，初选后获取相关文献全文，并采用Cochrane协作网推荐的偏倚风险评价工具对试验进行评价。文献数据由两名研究者独立提取，并采用RevMan5.1软件进行Meta分析。结果：按照严格的纳入标准，最终肾部分切除术和肾癌根治术疗效和安全性比较的临床对照研究文献共6篇，总共纳入15740例患者，肾部分切除术组1841例，肾癌根治术组13926例。Meta分析结果示：（1）在6个研究中有4个试验可以提取肾部分切除术和肾癌根治术关于术后5年总的生存率的比较的相关数据，经RevMan5.1软件统计分析合并数据后得RR=1.02，95%CI=（0.94，1.12），P=0.00030.1，Z=0.54，肾部分切除术和肾癌根治术治疗T1b期肾癌术后5年总生存率的差异无统计学意义。（2）在6个研究中有4个试验可以提取肾部分切除术和肾癌根治术关于术后5年肿瘤特异性生存率比较的相关数据，经RevMan5.1软件统计分析合并数据后得RR=1.11，95%CI=（1.04，1.18），P=0.80＞0.1，Z=3.24，肾部分切除术和肾癌根治术治疗T1b期肾癌术后5年肿瘤的特异性生存率的差异有统计学意义。（3）在6个研究中有2个试验可以提取肾部分切除术和肾癌根治术关于术后5年无瘤生存率比较的相关数据，经RevMan5.1软件统计分析合并数据后得RR=0.67，95%CI=（0.19，2.4），，P=0.010.1，Z=0.61，认为肾部分切除术和肾癌根治术治疗T1b期肾癌术后5年无瘤生存率的差异无统计学意义。（4）在6个研究中有2个试验可以提取肾部分切除术和肾癌根治术关于术后肿瘤转移情况的相关数据，经RevMan5.1软件统计分析合并数据后得RR=0.21，95%CI=（0.18，0.51），P=0.76＞0.1，Z=3.38，认为肾部分切除术和肾癌根治术治疗T1b期肾癌术后转移情况的差异有统计学意义。结论：以上结果表明：两种手术方式术后患者5年总的生存率、5年无瘤生存率差别无统计学意义；肾部分切除术组术后5年肿瘤特异性生存率优于肾癌根治术组，肾部分切除术组比肾癌根治术组术后更容易合并肿瘤转移。
[Abstract]:Objective: to summarize the difference between partial nephrectomy and radical nephrectomy in patients with stage T 1b renal carcinoma with normal contralateral renal function, and to provide evidence for the choice of surgical methods in patients with stage T 1b renal carcinoma. Methods: first of all, electronic and manual retrieval was used to check the related documents. The databases of electronic retrieval included Pub med/Medlinedatabase,Cochrane library, Embase,CNKI full text database of Chinese periodicals, Weipu database and Wanfang digital periodical group. And through a variety of mainstream search engines to find relevant literature. After the primary selection, the full text of the relevant literature was obtained, and the bias risk assessment tool recommended by Cochrane Cooperative Network was used to evaluate the experiment. The literature data were extracted independently by two researchers and Meta analysis was carried out with RevMan5.1 software. Results: according to the strict inclusion criteria, there were 6 clinical comparative studies on the efficacy and safety of the final partial nephrectomy and radical nephrectomy. A total of 15740 patients were included in the study, 1841 in the partial nephrectomy group. The results of Meta analysis showed that: (1) four of the 6 studies could extract the data from partial nephrectomy and radical nephrectomy on the overall 5-year survival rate. The RR=1.02,95%CI= (0.94m1.12), P0. 00030. 1 and ZX 0. 54 were obtained by statistical analysis of the combined data by RevMan5.1 software. There was no significant difference in 5-year overall survival rate between partial nephrectomy and radical nephrectomy for stage T 1b renal cell carcinoma. (2) four of the six studies could extract partial nephrectomy and radical nephrectomy. 5 year tumor-specific survival rate data, The RR=1.11,95%CI= (1.04m1.18), P0. 80 > 0. 1GZ 3. 24 were obtained by statistical analysis of the data by RevMan5.1 software. There was significant difference between partial nephrectomy and radical nephrectomy in the treatment of T1b stage renal cell carcinoma. (3) two of the 6 studies can extract partial nephrectomy and radical nephrectomy. (3) in 6 studies, two tests can be used to extract partial nephrectomy and radical nephrectomy. The relevant data of postoperative 5-year tumor-free survival rate, RR=0.67,95%CI= (0.19 ~ 2.4), P ~ (0.010. 1) ~ (Z) ~ (0.61), P ~ (0.010. 1) ~ (2 +) were obtained by statistical analysis of data by RevMan5.1 software. It is concluded that there is no significant difference between partial nephrectomy and radical nephrectomy in the treatment of T1b stage renal cell carcinoma. (4) two of the 6 studies can extract partial nephrectomy and radical nephrectomy. The relevant data of tumor metastasis after operation, RR=0.21,95%CI= (0.18 卤0.51) and P _ (0.76) > 0.1 ~ (1) Z ~ (3. 38) were obtained by RevMan5.1 software. It is concluded that there is a significant difference between partial nephrectomy and radical nephrectomy in the treatment of stage T 1b renal cell carcinoma after operation. Conclusion: the above results indicate that there is no significant difference in 5-year overall survival rate and 5-year tumor-free survival rate between the two surgical methods. The 5-year tumor specific survival rate of partial nephrectomy group was better than that of radical nephrectomy group, and partial nephrectomy group was more likely to be associated with tumor metastasis than that of radical nephrectomy group.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R737.11

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