UNASSIGNED:本研究旨在确定根治性膀胱切除术(RC)的最佳盆腔淋巴结清扫术(PLND)模板。
未经评估:使用PubMed进行了系统搜索,Embase和Cochrane图书馆数据库将于2021年12月发布。比较无复发生存率(RFS)的文章,疾病特异性生存率(DSS),总生存期(OS),以及接受有限PLND(LPLND)的患者的术后并发症,标准PLND(SPLND),扩展PLND(EPLND),或超延长PLND(SEPLND)被包括在内。采用贝叶斯方法进行网络荟萃分析。
未经评估:我们纳入了18项研究,17项研究符合我们的网络荟萃分析标准.我们进行了荟萃分析和网络荟萃分析,以调查四个PLND模板与RFS之间的关联。DSS,操作系统,或术后并发症。我们发现,ePLND组和sPLND组的RFS优于sPLND组(危险比[HR]:0.65,95%可信间隔[CrI]:0.56至0.78)(HR:0.67,95%CrI:0.56至0.83)和lPLND组(HR:0.67,95%CrI:0.50至0.91)(HR:0.70至95%:0.49)对于RFS,对治疗排名的分析表明,ePLND成为最佳模板的可能性最高。DSS中的四个模板之间没有显着差异,然而,对治疗排名的分析表明,SEPLND成为最佳模板的可能性最高。我们发现sPLND组和ePLND组的OS优于lPLND(HR:0.58,95%CrI:0.36至0.95)(HR:0.63,95%CrI:0.41至0.94)。对于操作系统,对治疗排名的分析表明,SEPLND成为最佳模板的可能性最高。荟萃分析和网络荟萃分析的结果表明,术后并发症的发生率在任何两个模板之间都没有显着差异。
UNASSIGNED:接受seplND和ePLND的患者有更好的RFS,但与接受lPLND或sPLND模板的患者相比,没有更好的DSS或OS。然而,RFS在接受sePLND或ePLND的患者之间没有差异。考虑到SEPLND涉及更长的操作时间,风险较高,难度比ePLND更大,进行SEPLND可能不会导致更好的预后,所以似乎不需要seLPND。我们认为ePLND可能是RC的最佳PLND模板。
UNASSIGNED:https://www。crd.约克。AC.英国/普华永道/,标识符CRD42022318475。
UNASSIGNED: This study aims to determine the optimal pelvic lymph node dissection (PLND) template for radical cystectomy (RC).
UNASSIGNED: A systematic search was conducted using the PubMed, Embase and Cochrane Library database in December 2021. Articles comparing recurrence-free survival (RFS), disease-specific survival (DSS), overall survival (OS), and postoperative complications among patients undergoing limited PLND (lPLND), standard PLND (sPLND), extended PLND (ePLND), or super-extended PLND (sePLND) were included. A Bayesian approach was used for network meta-analysis.
UNASSIGNED: We included 18 studies in this systematic review, and 17 studies met our criteria for network meta-analysis. We performed meta-analyses and network meta-analyses to investigate the associations between four PLND templates and the RFS, DSS, OS, or postoperative complications. We found that the ePLND group and the sePLND group were associated with better RFS than the sPLND group (Hazard Ratio [HR]: 0.65, 95% Credible Interval [CrI]: 0.56 to 0.78) (HR: 0.67, 95% CrI: 0.56 to 0.83) and the lPLND group (HR: 0.67, 95% CrI: 0.50 to 0.91) (HR: 0.70, 95% CrI: 0.49 to 0.99). For RFS, Analysis of the treatment ranking revealed that ePLND had the highest probabilities to be the best template. There was no significant difference between the four templates in DSS, however, analysis of the treatment ranking indicated that sePLND had the highest probabilities to be the best template. And We found that the sePLND group and the ePLND group were associated with better OS than lPLND (HR: 0.58, 95% CrI: 0.36 to 0.95) (HR: 0.63, 95% CrI: 0.41 to 0.94). For OS, analysis of the treatment ranking revealed that sePLND had the highest probabilities to be the best template. The results of meta-analyses and network meta-analyses showed that postoperative complications rates did not differ significantly between any two templates.
UNASSIGNED: Patients undergoing sePLND and ePLND had better RFS but not better DSS or OS than those undergoing lPLND or sPLND templates, however, RFS did not differ between patients undergoing sePLND or ePLND. Considering that sePLND involves longer operation time, higher risk, and greater degree of difficulty than ePLND, and performing sePLND may not result in better prognosis, so it seems that there is no need for seLPND. We think that ePLND might be the optimal PLND template for RC.
UNASSIGNED: https://www.crd.york.ac.uk/prospero/, identifier CRD42022318475.