淋巴血管侵犯在评价根治性前列腺癌切除术后患者生化复发方面的系统性回顾与分析
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摘要
目的系统性评价与分析淋巴血管侵犯在行根治性前列腺癌切除术后患者中的临床意义。方法通过计算机在线检索PubMed、EMBASE、Web of Science、中国数字图书馆、万方、维普数据库中有关淋巴血管侵犯与根治性前列腺癌切除术后患者生化复发方面的研究,同时手工检索纳入文献的参考文献。相关检索时间设置为建库开始至2018年3月,检索语种为英文及中文。采用Stata 12.0软件进行相关的数据分析与统计工作。结果最终共纳入18篇回顾性队列研究,发表时间从2004年至2017年。相关患者共23 775例,其中淋巴血管侵犯患者7 742例,所占比例为32.6%。单因素分析结果汇总显示在行根治性切除术后发生淋巴血管侵犯的前列腺癌患者生化复发率[HR=1.41,95%CI(1.28～1.55),P<0.001]显著升高。多因素分析进一步确认淋巴血管侵犯是根治性前列腺切除术后发生生化复发的独立影响因子[HR=1.24,95%CI(1.16～1.33),P<0.001]。敏感性分析结果显示单因素分析模型中合并HR值在1.30(1.25～1.36)与1.45(1.29,1.63)之间,多因素分析模型中合并HR值范围在1.22(1.15～1.30)到1.26(1.17～1.34)。Begg's发表偏倚分析结果显示单因素(t=2.03,P=0.073)与多因素(t=0.49,P=0.632)分析模型中均无显著发表偏倚存在。结论淋巴血管侵犯与根治性前列腺癌切除术后患者的生化复发呈显著性相关,可作为评价此类患者术后生化复发方面的独立危险因子。
Objective To systematically evaluate the prognostic role of lymphovascular invasion(LVI)in predicting the biochemical recurrence(BCR)in patients with prostate cancer(PCa)after radical prostatectomy(RC).Methods Studies about BCR outcomes of PCa patients with LVI following RC were searched in the databases including PubMed,EMBASE,Web of Science,Cochrane library,China National Knowledge Infrastructure(CNKI),Wanfang and vip citation database up to March2018.Moreover,the relevant literature was manually searched to find additional publications of interest.The languages of publications were English and Chinese.The data collected were analyzed with Stata 12.0software.Results A total of 18 retrospective cohort studies published during 2004 and 2017 were included,involving 23 775 PCa patients,7 742(32.6%)of which had LVI.Univariate analysis showed that LVI was associated with higher BCR risk[pooled HR=1.41,95%CI:(1.28-1.55),P<0.001],and multivariate analysis showed that LVI was an independent risk factor of BCR after RC [pooled HR=1.24,95%CI:(1.16～1.33),P<0.001].The summary relative risk estimate(SRRE)for BCR ranged from 1.30(1.25-1.36)to 1.45(1.29-1.63)in univariate analysis,and from1.22(1.15-1.30)to 1.26(1.17-1.34)in multivariate analysis.No significant publication bias was detected among these studies regarding HR of BCR in univariate(t=2.03,P=0.073)and multivariate analysis(t=0.49,P=0.632).Conclusion LVI is significantly associated with BCR in PCa patients after RC.It may serve as an independent risk factor to evaluate the postoperative BCR risk in PCa patients.
Objective To systematically evaluate the prognostic role of lymphovascular invasion(LVI)in predicting the biochemical recurrence(BCR)in patients with prostate cancer(PCa)after radical prostatectomy(RC).Methods Studies about BCR outcomes of PCa patients with LVI following RC were searched in the databases including PubMed,EMBASE,Web of Science,Cochrane library,China National Knowledge Infrastructure(CNKI),Wanfang and vip citation database up to March2018.Moreover,the relevant literature was manually searched to find additional publications of interest.The languages of publications were English and Chinese.The data collected were analyzed with Stata 12.0software.Results A total of 18 retrospective cohort studies published during 2004 and 2017 were included,involving 23 775 PCa patients,7 742(32.6%)of which had LVI.Univariate analysis showed that LVI was associated with higher BCR risk[pooled HR=1.41,95%CI:(1.28-1.55),P<0.001],and multivariate analysis showed that LVI was an independent risk factor of BCR after RC [pooled HR=1.24,95%CI:(1.16～1.33),P<0.001].The summary relative risk estimate(SRRE)for BCR ranged from 1.30(1.25-1.36)to 1.45(1.29-1.63)in univariate analysis,and from1.22(1.15-1.30)to 1.26(1.17-1.34)in multivariate analysis.No significant publication bias was detected among these studies regarding HR of BCR in univariate(t=2.03,P=0.073)and multivariate analysis(t=0.49,P=0.632).Conclusion LVI is significantly associated with BCR in PCa patients after RC.It may serve as an independent risk factor to evaluate the postoperative BCR risk in PCa patients.
引文
[1]SIEGEL RL,MILLER KD,JEMAL A,et al.Cancer statistics,2017[J].CA Cancer J Clin,2017,67(1):7-30.
[2]LEE DJ,MALLIN K,GRAVES AJ,et al.Recent changes in prostate cancer screening practices and prostate cancer epidemiology[J].J Urol,198(6):1230-1240.
[3]FAKHREJAHANI F,MADAN RA,DAHUT WL,et al.Management options for biochemically recurrent prostate cancer[J].Curr Treat Options Oncol,2017,18(5):26.
[4]喻希,葛鹏,王子成,等.根治性膀胱切除标本中淋巴血管侵犯的预后判断价值研究[J].中华泌尿外科杂志,2015,36(2):122-125.
[5]KANG YJ,KIM HS,JANG WS,et al.Impact of lymphovascular invasion on lymph node metastasis for patients undergoing radical prostatectomy with negative resection margin[J].BMC Cancer,2017,8,17(1):321.
[6]LIBERATI A,ALTMAN DG,TETZLAFF J,et al.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions:explanation and elaboration[J].J Clin Epidemiol,2009,62(10):e1-34.
[7]ZENG X,ZHANG Y,KWONG JS,et al.The methodological quality assessment tools for preclinical and clinical studies,systematic review and meta-analysis,and clinical practice guideline:a systematic review[J].J Evid Based Med,2015,8(1):2-10.
[8]FUJIMURA T,FUKUHARA H,TAGUCHI S,et al.Robot-assisted radical prostatectomy significantly reduced biochemical recurrence compared to retro pubic radical prostatectomy[J].BMC Cancer,2017,29,17(1):454.
[9]SEVCENCO S,MATHIEU R,BALTZER P,et al.The prognostic role of preoperative serum C-reactive protein in predicting the biochemical recurrence in patients treated with radical prostatectomy[J].Prostate Cancer Prostatic Dis,2016,19(2):163-167.
[10]PAGANO MJ,WHALEN MJ,PAULUCCI DJ,et al.Predictors of biochemical recurrence in pT3bprostate cancer after radical prostatectomy without adjuvant radiotherapy[J].Prostate,2016,76(2):226-234.
[11]FAJKOVIC H,MATHIEU R,LUCCA I,et al.Validation of lymphovascular invasion is an independent prognostic factor for biochemical recurrence after radical prostatectomy[J].Urol Oncol,2016,34(5):233.e1-6.
[12]LEE D,LEE C,KWON T,et al.Clinical features and prognosis of prostate cancer with high-grade prostatic intraepithelial neoplasia[J].Korean J Urol,2015,56(8):565-571.
[13]YOU D,JEONG IG,SONG C,et al.High percent tumor volume predicts biochemical recurrence after radical prostatectomy in pathological stage T3aprostate cancer with a negative surgical margin[J].Int J Urol,2014,21(5):484-489.
[14]CHROMECKI TF,CHA EK,PUMMER K,et al.Prognostic value of insulin-like growth factor II mRNA binding protein 3in patients treated with radical prostatectomy[J].BJU Int,2012,110(1):63-68.
[15]JUNG JH,LEE JW,ARKONCEL FR,et al.Significance of perineural invasion,lymphovascular invasion,and high-grade prostatic intraepithelial neoplasia in robot-assisted laparoscopic radical prostatectomy[J].Ann Surg Oncol,2011,18(13):3828-3832.
[16]CHO IC,CHUNG HS,CHO KS,et al.Bcl-2as a predictive factor for biochemical recurrence after radical prostatectomy:an interim analysis[J].Cancer Res Treat,2010,42(3):157-162.
[17]JEON HG,BAE J,YI JS,et al.Perineural invasion is a prognostic factor for biochemical failure after radical prostatectomy[J].Int J Urol,2009,16(8):682-686.
[18]SHARIATh SF,KHODDAMI SM,SABOORIAN H,et al.Lymphovascular invasion is a pathological feature of biologically aggressive disease in patients treated with radical prostatectomy[J].J Urol,2004,171(3):1122-1127.
[19]YEE DS,SHARIAT SF,LOWRANCE WT,et al.Prognostic significance of lymphovascular invasion in radical prostatectomy specimens[J].BJU Int,2011,108(4):502-507.
[20]LEE JT,LEE S,YUN CJ,et al.Prediction of perineural invasion and its prognostic value in patients with prostate cancer[J].Korean J Urol,2010,51(11):745-751.
[21]YAMAMOTO S,KAWAKAMI S,YONESE J,et al.Lymphovascular invasion is an independent predictor of prostate-specific antigen failure after radical prostatectomy in patients with pT3aN0prostate cancer[J].Int J Urol,2008,15(10):895-899.
[22]MAY M,KAUFMANN O,HAMMERMANN F,et al.Prognostic impact of lymphovascular invasion in radical prostatectomy specimens[J].BJU Int,2007,99(3):539-544.
[23]LOEB S,ROEHL KA,YU X,et al.Lymphovascular invasion in radical prostatectomy specimens:prediction of adverse pathologic features and biochemical progression[J].Urology,2006,68(1):99-103.
[24]CHENG L,JONES TD,LIN H,et al.Lymphovascular invasion is an independent prognostic factor in prostatic adenocarcinoma[J].J Urol,2005,174(6):2181-2185.
[25]鲁欣,任善成,孙颖浩,等.前列腺癌根治术后生化复发的诊断和治疗[J].中华泌尿外科杂志,2007,28(12):861-863.
[2]LEE DJ,MALLIN K,GRAVES AJ,et al.Recent changes in prostate cancer screening practices and prostate cancer epidemiology[J].J Urol,198(6):1230-1240.
[3]FAKHREJAHANI F,MADAN RA,DAHUT WL,et al.Management options for biochemically recurrent prostate cancer[J].Curr Treat Options Oncol,2017,18(5):26.
[4]喻希,葛鹏,王子成,等.根治性膀胱切除标本中淋巴血管侵犯的预后判断价值研究[J].中华泌尿外科杂志,2015,36(2):122-125.
[5]KANG YJ,KIM HS,JANG WS,et al.Impact of lymphovascular invasion on lymph node metastasis for patients undergoing radical prostatectomy with negative resection margin[J].BMC Cancer,2017,8,17(1):321.
[6]LIBERATI A,ALTMAN DG,TETZLAFF J,et al.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions:explanation and elaboration[J].J Clin Epidemiol,2009,62(10):e1-34.
[7]ZENG X,ZHANG Y,KWONG JS,et al.The methodological quality assessment tools for preclinical and clinical studies,systematic review and meta-analysis,and clinical practice guideline:a systematic review[J].J Evid Based Med,2015,8(1):2-10.
[8]FUJIMURA T,FUKUHARA H,TAGUCHI S,et al.Robot-assisted radical prostatectomy significantly reduced biochemical recurrence compared to retro pubic radical prostatectomy[J].BMC Cancer,2017,29,17(1):454.
[9]SEVCENCO S,MATHIEU R,BALTZER P,et al.The prognostic role of preoperative serum C-reactive protein in predicting the biochemical recurrence in patients treated with radical prostatectomy[J].Prostate Cancer Prostatic Dis,2016,19(2):163-167.
[10]PAGANO MJ,WHALEN MJ,PAULUCCI DJ,et al.Predictors of biochemical recurrence in pT3bprostate cancer after radical prostatectomy without adjuvant radiotherapy[J].Prostate,2016,76(2):226-234.
[11]FAJKOVIC H,MATHIEU R,LUCCA I,et al.Validation of lymphovascular invasion is an independent prognostic factor for biochemical recurrence after radical prostatectomy[J].Urol Oncol,2016,34(5):233.e1-6.
[12]LEE D,LEE C,KWON T,et al.Clinical features and prognosis of prostate cancer with high-grade prostatic intraepithelial neoplasia[J].Korean J Urol,2015,56(8):565-571.
[13]YOU D,JEONG IG,SONG C,et al.High percent tumor volume predicts biochemical recurrence after radical prostatectomy in pathological stage T3aprostate cancer with a negative surgical margin[J].Int J Urol,2014,21(5):484-489.
[14]CHROMECKI TF,CHA EK,PUMMER K,et al.Prognostic value of insulin-like growth factor II mRNA binding protein 3in patients treated with radical prostatectomy[J].BJU Int,2012,110(1):63-68.
[15]JUNG JH,LEE JW,ARKONCEL FR,et al.Significance of perineural invasion,lymphovascular invasion,and high-grade prostatic intraepithelial neoplasia in robot-assisted laparoscopic radical prostatectomy[J].Ann Surg Oncol,2011,18(13):3828-3832.
[16]CHO IC,CHUNG HS,CHO KS,et al.Bcl-2as a predictive factor for biochemical recurrence after radical prostatectomy:an interim analysis[J].Cancer Res Treat,2010,42(3):157-162.
[17]JEON HG,BAE J,YI JS,et al.Perineural invasion is a prognostic factor for biochemical failure after radical prostatectomy[J].Int J Urol,2009,16(8):682-686.
[18]SHARIATh SF,KHODDAMI SM,SABOORIAN H,et al.Lymphovascular invasion is a pathological feature of biologically aggressive disease in patients treated with radical prostatectomy[J].J Urol,2004,171(3):1122-1127.
[19]YEE DS,SHARIAT SF,LOWRANCE WT,et al.Prognostic significance of lymphovascular invasion in radical prostatectomy specimens[J].BJU Int,2011,108(4):502-507.
[20]LEE JT,LEE S,YUN CJ,et al.Prediction of perineural invasion and its prognostic value in patients with prostate cancer[J].Korean J Urol,2010,51(11):745-751.
[21]YAMAMOTO S,KAWAKAMI S,YONESE J,et al.Lymphovascular invasion is an independent predictor of prostate-specific antigen failure after radical prostatectomy in patients with pT3aN0prostate cancer[J].Int J Urol,2008,15(10):895-899.
[22]MAY M,KAUFMANN O,HAMMERMANN F,et al.Prognostic impact of lymphovascular invasion in radical prostatectomy specimens[J].BJU Int,2007,99(3):539-544.
[23]LOEB S,ROEHL KA,YU X,et al.Lymphovascular invasion in radical prostatectomy specimens:prediction of adverse pathologic features and biochemical progression[J].Urology,2006,68(1):99-103.
[24]CHENG L,JONES TD,LIN H,et al.Lymphovascular invasion is an independent prognostic factor in prostatic adenocarcinoma[J].J Urol,2005,174(6):2181-2185.
[25]鲁欣,任善成,孙颖浩,等.前列腺癌根治术后生化复发的诊断和治疗[J].中华泌尿外科杂志,2007,28(12):861-863.