Gupta S, King W D, Korzeniowski M, Wallace D L, Mackillop W J
Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
Clin Oncol (R Coll Radiol). 2016 Dec;28(12):739-749. doi: 10.1016/j.clon.2016.07.010. Epub 2016 Aug 3.
AIMS: To determine the effect of delay in postoperative radiotherapy on local recurrence and overall survival in women receiving partial mastectomy for breast cancer. MATERIALS AND METHODS: This was a systematic review and meta-analysis of published literature. Relevant reports were identified from MEDLINE, EMBASE and the Cochrane Register of Controlled Trials in all languages from 1975 to April 2015, in addition to the abstracts from the annual meetings of major radiotherapy conferences from 2000 to 2011. Reference lists were hand searched to find additional relevant reports and OvidSP's 'Find Citing' function was used to find studies citing papers identified in the primary search. Studies were included if they met the following criteria: (i) all patients received partial mastectomy and radiotherapy, (ii) a delay from surgery to radiotherapy was reported and (iii) one or more of local control/failure and/or survival were reported. Observational studies and randomised controlled trials were included. Studies including patients with in situ disease were excluded. Studies were classified as high quality if they adequately controlled for factors known to be associated with the outcomes of interest. Study quality was independently assessed by three authors. Initial disagreements about three studies were resolved by consensus. Only high-quality studies were included in the primary analysis. Delay was modelled as a continuous variable and the relative risk of local recurrence and the relative risk of death are reported per month of delay. The study results were combined using a fixed-effects model. RESULTS: Thirty-four relevant publications including 79 616 patients were identified in the systematic review. Ten high-quality publications reported on local recurrence (13 291 patients) and four high-quality studies reported on overall survival (2207 patients). The relative risk of local recurrence per month of delay was 1.08 (95% confidence interval 1.02-1.14). The relative risk of death per month of delay was 0.99 (95% confidence interval 0.94-1.05). CONCLUSIONS: Delays in post-lumpectomy radiotherapy are associated with a significant increase in the risk of local recurrence. We recommend that waiting times for radiotherapy should be kept as short as reasonably achievable.
目的：确定乳腺癌保乳术后延迟进行放射治疗对局部复发和总生存率的影响。 材料与方法：这是一项对已发表文献的系统评价和荟萃分析。除了2000年至2011年主要放射治疗会议年会的摘要外，还从MEDLINE、EMBASE和Cochrane对照试验注册库中检索了1975年至2015年4月所有语言的相关报告。通过手工检索参考文献列表以查找其他相关报告，并使用OvidSP的“查找引用文献”功能查找引用在初步检索中确定的论文的研究。符合以下标准的研究纳入分析：（i）所有患者均接受了保乳手术和放射治疗；（ii）报告了从手术到放射治疗的延迟时间；（iii）报告了局部控制/失败和/或生存情况中的一项或多项。纳入观察性研究和随机对照试验。排除纳入原位疾病患者的研究。如果研究充分控制了已知与感兴趣结局相关的因素，则将其分类为高质量研究。研究质量由三位作者独立评估。关于三项研究的最初分歧通过共识解决。仅将高质量研究纳入初步分析。将延迟建模为连续变量，并报告每月延迟的局部复发相对风险和死亡相对风险。使用固定效应模型合并研究结果。 结果：在系统评价中确定了34篇相关出版物，包括79616例患者。10篇高质量出版物报告了局部复发情况（13291例患者），4篇高质量研究报告了总生存情况（2207例患者）。每月延迟的局部复发相对风险为1.08（95%置信区间1.02 - 1.14）。每月延迟的死亡相对风险为0.99（95%置信区间0.94 - 1.05）。 结论：保乳术后放射治疗的延迟与局部复发风险的显著增加相关。我们建议放疗的等待时间应尽可能合理地缩短。
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