复发性喉返神经淋巴结清扫在食管鳞状细胞癌中的预后意义：系统评价与荟萃分析
Prognostic significance of recurrent laryngeal nerve lymph node dissection in esophageal squamous cell carcinoma: a systematic review and meta-analysis.
文献信息
| PMID | 42724238 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Sukai Xu |
| 作者单位 | Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China. |
| 期刊 | Journal of thoracic disease |
| SCI 分区 | Q3 |
| IF | 2.6 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 复发性喉返神经淋巴结清扫（RLN-LND）能否改善食管鳞状细胞癌（ESCC）患者的生存仍存在争议。本系统评价与荟萃分析旨在评估RLN-LND在接受根治性食管切除术的ESCC患者中的预后意义。
方法： 我们系统检索了Web of Science、PubMed、Cochrane Library和Embase自建库至2026年6月的研究，比较ESCC患者中RLN-LND组与非RLN-LND组的总生存期（OS）和无病生存期（DFS）。纳入标准基于PICOS框架：人群——接受根治性食管切除术的ESCC患者；干预——RLN-LND；对照——非RLN-LND；结局——OS和DFS；研究设计——随机对照试验（RCT）和观察性研究。采用纽卡斯尔-渥太华量表（NOS）评估偏倚风险。使用RevMan 5.4和Stata 15.0进行荟萃分析。通过漏斗图、Begg检验、Egger检验和剪补法评估发表偏倚。通过Q检验和I2评估异质性。
结果： 共纳入7项回顾性研究，涉及4,570例患者（RLN-LND组3,133例，非RLN-LND组1,437例）。所有研究均被评为高质量（NOS评分≥7）。荟萃分析显示，与非RLN-LND组相比，RLN-LND组的OS改善[风险比（HR）=0.69，95%置信区间（CI）：0.57-0.84，P<0.001]，DFS也改善（HR=0.65，95%CI：0.44-0.97，P=0.04）。然而，亚组分析显示，在接受新辅助治疗加手术的患者中，OS获益无统计学意义（HR=0.71，95%CI：0.37-1.36，P=0.30）。
结论： 基于高质量回顾性证据，RLN-LND可能与接受初始手术的ESCC患者OS和DFS改善相关，但在接受新辅助治疗的患者中则不然。由于纳入研究的非随机性质、潜在的未校正混杂因素以及回顾性设计固有的局限性，这些发现应谨慎解读。有必要开展前瞻性多中心研究以证实这些结果。
英文摘要
BACKGROUND: Whether recurrent laryngeal nerve lymph node dissection (RLN-LND) improves survival in esophageal squamous cell carcinoma (ESCC) remains controversial. This systematic review and meta-analysis aimed to evaluate the prognostic significance of RLN-LND in ESCC patients undergoing radical esophagectomy.
METHODS: We systematically searched Web of Science, PubMed, Cochrane Library, and Embase from inception to June 2026 for studies comparing overall survival (OS) and disease-free survival (DFS) between RLN-LND and non-RLN-LND groups in ESCC patients. Eligibility criteria were based on PICOS framework: population-ESCC patients undergoing radical esophagectomy; intervention-RLN-LND; comparison-non-RLN-LND; outcomes-OS and DFS; study design-randomized controlled trials (RCTs) and observational studies. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.4 and Stata 15.0. Publication bias was evaluated by funnel plots, Begg's test, Egger's test, and trim-and-fill method. Heterogeneity was assessed by Q-test and I2.
RESULTS: Seven retrospective studies involving 4,570 patients (3,133 in RLN-LND group and 1,437 in non-RLN-LND group) were included. All studies were rated as high quality (NOS scores ≥7). Meta-analysis showed improved OS [hazard ratio (HR) =0.69, 95% confidence interval (CI): 0.57-0.84, P<0.001] and DFS (HR =0.65, 95% CI: 0.44-0.97, P=0.04) in the RLN-LND group versus the non-RLN-LND group. However, subgroup analysis showed no significant OS benefit in patients receiving neoadjuvant therapy plus surgery (HR =0.71, 95% CI: 0.37-1.36, P=0.30).
CONCLUSIONS: Based on high-quality retrospective evidence, RLN-LND may be associated with improved OS and DFS in ESCC patients undergoing upfront surgery, but not in those receiving neoadjuvant therapy. These findings should be interpreted with caution due to the non-randomized nature of included studies, potential unadjusted confounding, and inherent limitations of retrospective designs. Prospective multicenter studies are warranted to confirm these results.