本文選題：IA期 + 非小細(xì)胞肺癌�。� 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:隨著科技的進(jìn)步,各種先進(jìn)醫(yī)療設(shè)備如HRCT LDCT PET/CT的應(yīng)用,肺內(nèi)較為小的病變,容易被體檢發(fā)現(xiàn),國(guó)內(nèi)外早期肺癌被診斷的數(shù)量持續(xù)增加。而關(guān)于早期肺癌的手術(shù)方式卻一直存在爭(zhēng)議。過去根治性肺葉切除是手術(shù)治療早期肺癌的標(biāo)準(zhǔn),但當(dāng)前許多研究學(xué)者認(rèn)為,肺葉切除可能存在過度治療,已有研究表明亞肺葉切除可取得與肺葉切除同樣的治療效果。但就早期肺癌的多項(xiàng)研究均存在沖突。因此本研究通過對(duì)已發(fā)表的文獻(xiàn)進(jìn)行Meta分析,研究IA期非小細(xì)胞肺癌計(jì)劃性亞肺葉切除與肺葉切除術(shù)后總生存期和無病生存期。方法:應(yīng)用國(guó)內(nèi)著名文獻(xiàn)檢索網(wǎng)站(中國(guó)知網(wǎng)數(shù)據(jù)庫(kù)CNKI,萬(wàn)方數(shù)據(jù)庫(kù))及國(guó)外知名文獻(xiàn)網(wǎng)站(Ovid Medline,EMBASE,Pub Med)采用相關(guān)檢索詞對(duì)相關(guān)文獻(xiàn)全面檢索,通過制定相應(yīng)納入與排除標(biāo)準(zhǔn),對(duì)文獻(xiàn)進(jìn)行評(píng)估與篩選,最后得出相應(yīng)納入文獻(xiàn)。數(shù)據(jù)提取,對(duì)納入文獻(xiàn)進(jìn)行相關(guān)數(shù)據(jù)提取。應(yīng)用Meta分析軟件Revman5,對(duì)數(shù)據(jù)整合得出結(jié)果。結(jié)果:1對(duì)于IA期肺癌,通過檢索共納入可研究文章8篇,共755人行計(jì)劃性亞肺葉切除,1280人行肺葉切除。通過整合數(shù)據(jù)對(duì)比兩種手術(shù)方式得出,5年生存率無明顯差異(HR 0.74[95%可信區(qū)間0.47-1.15])。通過對(duì)無病生存率可用文獻(xiàn)整合,得出RFS HR 0.79;(95%可信區(qū)間0.57-1.10)。2對(duì)于T1a N0M0早期肺癌研究,共納入6項(xiàng)文章,共632人行計(jì)劃性亞肺葉切,1045人行肺葉切除,得出5年生存率[HR 0.64;95%可信區(qū)間0.39-1.05]。同樣兩種手術(shù)對(duì)患者生存率無明顯影響。結(jié)論:通過分析可用相關(guān)文獻(xiàn),應(yīng)用Meta分析方法對(duì)數(shù)據(jù)整合,對(duì)于IA期肺癌,尤其是T1a N0M0,相似的5年生存率或無病生存率,或許計(jì)劃性亞肺葉切除為一種可以代替肺葉切除的手術(shù)選擇方式。但由于文章的高度選擇性,資料偏倚存在,期望將來的隨機(jī)對(duì)照臨床試驗(yàn)?zāi)軌蜃C實(shí)這一結(jié)論,為臨床實(shí)踐提供更好依據(jù)。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R734.2

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