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新辅助化疗取得良好反应后，局部晚期乳腺癌保乳手术与乳房切除术的比较：一项遵循PRISMA标准的系统评价和荟萃分析

Comparison of breast-conserving surgery with mastectomy in locally advanced breast cancer after good response to neoadjuvant chemotherapy: A PRISMA-compliant systematic review and meta-analysis.

作者信息

Sun Yixuan, Liao Mingjuan, He Liu, Zhu Chenfang

机构信息

Department of General Surgery Department of Traditional Chinese Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, 200011, China.

出版信息

Medicine (Baltimore). 2017 Oct;96(43):e8367. doi: 10.1097/MD.0000000000008367.

DOI:10.1097/MD.0000000000008367
PMID:29069026
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5671859/
Abstract

BACKGROUND

The application of breast-conserving surgery (BCS) on patients with locally advanced breast cancer (LABC) with good response to neoadjuvant chemotherapy (NACT) still remains controversial. The objective in this study is to analyze the safety of BCS in the management of LABC in patients with good response to NACT.

METHODS

We searched the electronic databases of Medline (Pubmed) and Cochrane Library for reports on local recurrence (LR), regional recurrence (RR), distant recurrence (DR), 5-year disease-free survival (DFS) or 5-year overall survival (OS) in patients with LABC receiving BCS or mastectomy (MT) and with good response to NACT. Based on the research results, we conducted a meta-analysis using Review Manager 5.3.

RESULTS

Our study showed that 16 studies with a combined total of 3531 patients, of whom 1465 patients underwent BCS, whereas 2066 patients underwent MT. There was no significant heterogeneity among these studies (Q statistic: P = .88; I = 0%). Patients with good response to NACT showed no significant difference in LR and RR [odd ratio (OR) = 0.83; 95% confidence interval (CI): 0.60-1.15; P = .26; OR = 0.56; 95% CI: 0.33-0.93; P = .03], while we figured out a lower DR (OR = 0.51; 95% CI: 0.42-0.63; P < .01), a higher DFS (OR = 2.35; 95% CI: 1.84 to 3.01, P < .01) and a higher OS (OR = 2.12; 95% CI: 1.51 to 2.98, P < .01) in BCS compared with MT.

CONCLUSION

This meta-analysis concluded that BCS was a safe surgery for patients with LABC and had good response to NACT.

摘要

背景

对于新辅助化疗（NACT）反应良好的局部晚期乳腺癌（LABC）患者，保乳手术（BCS）的应用仍存在争议。本研究的目的是分析BCS在治疗对NACT反应良好的LABC患者中的安全性。

方法

我们检索了Medline（Pubmed）和Cochrane图书馆的电子数据库，以获取有关接受BCS或乳房切除术（MT）且对NACT反应良好的LABC患者的局部复发（LR）、区域复发（RR）、远处复发（DR）、5年无病生存率（DFS）或5年总生存率（OS）的报告。基于研究结果，我们使用Review Manager 5.3进行了荟萃分析。

结果

我们的研究表明，16项研究共有3531名患者，其中1465名患者接受了BCS，而2066名患者接受了MT。这些研究之间没有显著的异质性（Q统计量：P = 0.88；I² = 0%）。对NACT反应良好的患者在LR和RR方面没有显著差异[比值比（OR）= 0.83；95%置信区间（CI）：0.60 - 1.15；P = 0.26；OR = 0.56；95% CI：0.33 - 0.93；P = 0.03]，而我们发现与MT相比，BCS的DR较低（OR = 0.51；95% CI：0.42 - 0.63；P < 0.01），DFS较高（OR = 2.35；95% CI：1.84至3.01，P < 0.01），OS也较高（OR = 2.12；95% CI：1.51至2.98，P < 0.01）。

结论

这项荟萃分析得出结论，对于对NACT反应良好的LABC患者，BCS是一种安全的手术方式。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63ee/5671859/5f74235040db/medi-96-e8367-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63ee/5671859/029bb4c578e0/medi-96-e8367-g001.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63ee/5671859/d9dd934dcc9c/medi-96-e8367-g008.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63ee/5671859/5f74235040db/medi-96-e8367-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63ee/5671859/029bb4c578e0/medi-96-e8367-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63ee/5671859/8151f174f682/medi-96-e8367-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63ee/5671859/94219c6bed93/medi-96-e8367-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63ee/5671859/29afe9393e6e/medi-96-e8367-g007.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63ee/5671859/9666215097b0/medi-96-e8367-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63ee/5671859/5f74235040db/medi-96-e8367-g010.jpg

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