计划性亚肺叶切除与肺叶切除治疗ⅠA期非小细胞肺癌的Meta分析

发布时间：2018-06-14 17:08

本文选题：IA期 + 非小细胞肺癌　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:随着科技的进步,各种先进医疗设备如HRCT LDCT PET/CT的应用,肺内较为小的病变,容易被体检发现,国内外早期肺癌被诊断的数量持续增加。而关于早期肺癌的手术方式却一直存在争议。过去根治性肺叶切除是手术治疗早期肺癌的标准,但当前许多研究学者认为,肺叶切除可能存在过度治疗,已有研究表明亚肺叶切除可取得与肺叶切除同样的治疗效果。但就早期肺癌的多项研究均存在冲突。因此本研究通过对已发表的文献进行Meta分析,研究IA期非小细胞肺癌计划性亚肺叶切除与肺叶切除术后总生存期和无病生存期。方法:应用国内著名文献检索网站(中国知网数据库CNKI,万方数据库)及国外知名文献网站(Ovid Medline,EMBASE,Pub Med)采用相关检索词对相关文献全面检索,通过制定相应纳入与排除标准,对文献进行评估与筛选,最后得出相应纳入文献。数据提取,对纳入文献进行相关数据提取。应用Meta分析软件Revman5,对数据整合得出结果。结果:1对于IA期肺癌,通过检索共纳入可研究文章8篇,共755人行计划性亚肺叶切除,1280人行肺叶切除。通过整合数据对比两种手术方式得出,5年生存率无明显差异(HR 0.74[95%可信区间0.47-1.15])。通过对无病生存率可用文献整合,得出RFS HR 0.79;(95%可信区间0.57-1.10)。2对于T1a N0M0早期肺癌研究,共纳入6项文章,共632人行计划性亚肺叶切,1045人行肺叶切除,得出5年生存率[HR 0.64;95%可信区间0.39-1.05]。同样两种手术对患者生存率无明显影响。结论:通过分析可用相关文献,应用Meta分析方法对数据整合,对于IA期肺癌,尤其是T1a N0M0,相似的5年生存率或无病生存率,或许计划性亚肺叶切除为一种可以代替肺叶切除的手术选择方式。但由于文章的高度选择性,资料偏倚存在,期望将来的随机对照临床试验能够证实这一结论,为临床实践提供更好依据。
[Abstract]:Objective: with the development of science and technology, the application of various advanced medical equipment such as HRCT LDCT PET / CT, the small lesions in the lung, easy to be found by physical examination, the number of early lung cancer diagnosis at home and abroad continues to increase. However, the surgical methods of early lung cancer have been controversial. In the past radical lobectomy was the standard for early lung cancer. However many researchers believe that lobectomy may be overtreated. It has been shown that sublobectomy can achieve the same therapeutic effect as lobectomy. However, many studies on early lung cancer are in conflict. Therefore, by meta-analysis of published literature, we studied the total survival time and disease-free survival time after scheduled sublobectomy and lobectomy in IA stage non-small cell lung cancer (NSCLC). Methods: domestic famous literature retrieval website (CNKI, Wanfang database) and Ovid Medline EMBASE Pub Medb, a famous foreign literature website, were used to search the relevant documents, and the relevant inclusion and exclusion criteria were established. The literature is evaluated and screened, and the corresponding inclusion of the literature is obtained. Data extraction, including the literature for the relevant data extraction. Using Meta analysis software Revman 5, the results of data integration were obtained. Results in the case of stage IA lung cancer, 8 articles including 755 planned sublobectomy and 1280 lobectomy were included in the study. The 5 year survival rate was not significantly different from that of HR 0.74 [95% CI 0.47-1.15]. Based on the literature integration of disease-free survival rate, it was concluded that the RFS HR 0.79% confidence interval 0.57-1.10.2 for T1a N0M0 early lung cancer study included 6 articles, 632 planned sublobectomy and 1045 patients underwent lobectomy, and the 5-year survival rate was obtained [HR 0.6495% confidence interval 0.39-1.05]. The same two operations had no significant effect on the survival rate. Conclusion: by using Meta-analysis method to integrate the data, similar 5-year survival rate or disease-free survival rate was found for stage IA lung cancer, especially T1a N0M0. Perhaps planned sublobectomy is an alternative to lobectomy. However, due to the high selectivity of the article and the existence of data bias, it is expected that the future randomized controlled clinical trials can confirm this conclusion and provide a better basis for clinical practice.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R734.2

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