Schmidt-Hansen Mia, Bromham Nathan, Hasler Elise, Reed Malcolm W
National Collaborating Centre for Cancer, Park House, Greyfriars Road, Cardiff, CF10 3AF Wales, UK.
Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX UK ; Brighton and Sussex University Teaching Hospitals Trust, Brighton, UK.
Springerplus. 2016 Jan 27;5:85. doi: 10.1186/s40064-016-1712-9. eCollection 2016.
Traditionally, women with node-positive operable breast cancer have received complete axillary lymph node dissection (ALND), which is associated with significant morbidity, but recently less invasive alternatives have been explored. We conducted a systematic review of randomised controlled trials assessing alternative approaches to axillary surgery in patients with pathologically-confirmed sentinel node-positive operable breast cancer. We searched on 16/3/15 the Specialized Register of the Cochrane Breast Cancer group; CENTRAL; MEDLINE; PreMEDLINE; EMBASE; WHO International Clinical Trials Registry Portal; ClinicalTrials.gov; conference proceedings from ASCO and the San Antonio Breast Cancer meetings; checked reference lists and contacted authors to identify relevant studies. Double, independent study sifting, extraction, appraisal and summarising were undertaken using standard Cochrane Collaboration methodology. We included three studies (2020 patients) comparing ALND with sentinel lymph node dissection (SLND) to SLND alone, and two studies (1899 patients) comparing ALND to axillary radiotherapy (aRT). No differences in survival or recurrence were observed between ALND and SLND or aRT, but morbidity may have been increased in ALND, and all the results were subject to different biases, such as recruitment bias, performance bias, and outcome-reporting bias. Whilst it is encouraging that there appears to be no adverse effect on recurrence or survival, it will be appropriate to confirm these findings and provide additional data confirming quality of life effects and long term outcomes.
传统上，腋窝淋巴结阳性的可手术乳腺癌女性患者接受了完整的腋窝淋巴结清扫术（ALND），这与显著的发病率相关，但最近人们探索了侵入性较小的替代方法。我们对随机对照试验进行了系统评价，评估病理证实前哨淋巴结阳性的可手术乳腺癌患者腋窝手术的替代方法。我们于2015年3月16日检索了Cochrane乳腺癌小组的专业注册库；CENTRAL；MEDLINE；PreMEDLINE；EMBASE；世界卫生组织国际临床试验注册平台；ClinicalTrials.gov；美国临床肿瘤学会和圣安东尼奥乳腺癌会议的会议记录；检查参考文献列表并联系作者以识别相关研究。采用标准的Cochrane协作方法进行了双人独立的研究筛选、提取、评估和总结。我们纳入了三项研究（2020例患者），比较了ALND与前哨淋巴结活检术（SLND）加单独SLND，以及两项研究（1899例患者），比较了ALND与腋窝放疗（aRT）。在ALND与SLND或aRT之间未观察到生存或复发方面的差异，但ALND的发病率可能有所增加，并且所有结果都存在不同的偏倚，如招募偏倚、实施偏倚和结果报告偏倚。虽然令人鼓舞的是，似乎对复发或生存没有不良影响，但确认这些发现并提供额外数据以证实生活质量影响和长期结果将是合适的。
