cNO声门上型喉癌颈部淋巴结的处理方法的meta分析

发布时间：2018-10-05 11:18

【摘要】： 目的应用Meta分析对临床阴性(cN0)声门上型喉癌颈部淋巴结的治疗方法进行评价。方法根据Cochrane手册要求,制定检索方案。检索中国生物医学文献数据库(CBM)、Medline(OVID)、Cochrane图书馆和EMBASE数据库、杂志、学位论文等。制定严格的纳入和排除标准,对相关文献进行筛查,质量评价和资料提取。对同质的研究应用RevMan4.3软件进行Meta分析。以5年生存率(OS)、5年无病生存率(DFS)、5年疾病特异性生存率(DSS)、复发率及远处转移率为观察指标,在进行异质性检验后选用适当的模型与方法,进行合并统计量的检验、敏感性分析和发表偏倚分析。结果经筛选,有6篇文献符合循证分析的要求,对其进行Meta分析。结果提示:颈清与放疗相比,在患者5年疾病特异性生存率、5年无病生存率、5年总生存率、淋巴结转移及复发率方面,P值均大于0.05,差异无统计学意义。颈清与临床观察相比较,在患者5年疾病特异性生存率、5年总生存率方面,P值大于0.05,差异无统计学意义。颈清与放疗联合颈清的综合治疗相比较,在患者5年疾病特异性生存率方面,P值大于0.05,差异无统计学意义。结论在cN0声门上型喉癌颈部淋巴结的处理方法中,颈清与单纯放疗、颈清联合放疗的综合治疗、临床观察相比较,无明显差异。提示术者通过严格的术前评估,结合临床诊断,对部分cN0声门上型喉癌颈部淋巴结进行临床观察,并不影响疗效,并可减少对患者的损伤。但由于纳入的研究均是回顾性对照性研究,病例数量少,存在选择偏倚和测量偏倚的可能性。需要更多高质量的随机对照试验来进一步证实。
[Abstract]:Objective to evaluate the treatment of cN0 supraglottic carcinoma by Meta. Methods according to the requirements of Cochrane manual, the retrieval scheme was formulated. To search the Chinese biomedical literature database (CBM) Medline (OVID) and EMBASE database, journals, dissertations, etc. Establish strict inclusion and exclusion criteria, screen related documents, evaluate quality and extract data. The homogeneity of the study was analyzed by Meta using RevMan4.3 software. The 5-year (OS), 5-year disease-free survival rate, (DFS), 5-year disease-specific survival rate, (DSS), recurrence rate and distant metastasis rate were used as indicators. After heterogeneity test, appropriate models and methods were selected for combined statistical test. Sensitivity analysis and publication bias analysis. Results six articles met the requirement of evidence-based analysis and Meta analysis was carried out. The results showed that compared with radiotherapy, the 5-year disease specific survival rate, 5-year disease-free survival rate, 5-year overall survival rate, lymph node metastasis and recurrence rate were higher than 0.05 (P > 0.05). Compared with the clinical observation, the 5-year disease specific survival rate and the 5-year overall survival rate of the patients were higher than 0.05 (P > 0.05), and there was no significant difference between the two groups. Compared with the combined therapy of radiotherapy and radiotherapy, the 5-year disease specific survival rate was higher than 0.05 (P > 0.05), and there was no significant difference between the two groups. Conclusion in the treatment of cervical lymph nodes of cN0 supraglottic laryngocarcinoma, there is no significant difference between the combined treatment of cervical clearance and radiotherapy alone or combined with radiotherapy. It is suggested that the clinical observation of cervical lymph nodes of some cN0 supraglottic laryngocarcinoma by strict preoperative evaluation and clinical diagnosis can not affect the curative effect and reduce the injury to the patients. However, due to the fact that all the included studies are retrospective controlled studies, the number of cases is small, and there is the possibility of selective bias and measurement bias. More high-quality randomized controlled trials are needed for further confirmation.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R739.65

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