Lv Yang, He Lin, Wang Chao, Zhang Lijiu, Zhang Biyuan, Song Yuhua
Department of Oncology, The PLA Navy Anqing Hospital, Anqing, Anhui Province.
Breast Center B ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province.
Medicine (Baltimore). 2019 Feb;98(6):e14407. doi: 10.1097/MD.0000000000014407.
To integrate relevant clinical data of multicatheter accelerated partial breast irradiation (mAPBI) for reaching a comprehensive conclusion.
We did 3 meta-analyses for clinical outcomes including 1740 women from 4 articles, for acute radiotherapy (RT)-associated toxicity including 1255 patients from 5 articles, and for late RT-related toxicity involving 1565 patients from 9 papers. Clinical outcomes analyses were stratified by molecular subtypes, lymph nodes status, receptor status, and human epidermal growth factor receptor 2 (HER2) status.
For the Luminal A/B phenotypes, the disease relapse and failure in survival significantly decreased when compared with triple negative (TN)/HER2-amplified subtypes (P < .00001). The 5-year regional nodal recurrence (RNR), 5-year distant metastasis-free survival (DMFS) and 5-year disease free-survival (DFS) of TN patients were significantly superior to HER2-overexpression patients (P < .00001). The 5-year cause-specific survival (CSS), 5-year DMFS and 5-year overall survival (OS) in women with lymph nodes-negative were significantly improved versus patients with lymph nodes-positive (P = .0001). Conversely, the positive status of HER2 compared with negative one significantly increased the rate of local recurrence (LR) (P = .02). For acute toxicity, the morbidity of dermatitis was significantly higher than hematoma and implant infection (P = .01, P < .0001, respectively). For late toxicity, the occurrences of fibrosis (32%) and telangiectasia (14%) were significantly higher than other complications (P < .0001).
HER2-enriched subtype compared with other subtypes has significantly increased disease relapse and failure in survival. HER2-positive status is positively associated with an increased incidence of LR. Dermatitis is the most common acute RT-related toxicity and fibrosis is the first rife late RT-related toxicity.
整合多导管加速部分乳腺照射（mAPBI）的相关临床数据以得出全面结论。
我们针对临床结局进行了3项荟萃分析，其中4篇文章纳入了1740名女性；针对急性放疗（RT）相关毒性进行了3项荟萃分析，5篇文章纳入了1255名患者；针对晚期RT相关毒性进行了3项荟萃分析，9篇论文纳入了1565名患者。临床结局分析按分子亚型、淋巴结状态、受体状态和人表皮生长因子受体2（HER2）状态进行分层。
对于Luminal A/B表型，与三阴性（TN）/HER2扩增亚型相比，疾病复发和生存失败显著降低（P<0.00001）。TN患者的5年区域淋巴结复发（RNR）、5年无远处转移生存期（DMFS）和5年无病生存期（DFS）显著优于HER2过表达患者（P<0.00001）。淋巴结阴性女性的5年特定病因生存期（CSS）、5年DMFS和5年总生存期（OS）与淋巴结阳性患者相比显著改善（P=0.0001）。相反，HER2阳性状态与阴性状态相比，局部复发（LR）率显著增加（P=0.02）。对于急性毒性，皮炎的发病率显著高于血肿和植入物感染（分别为P=0.01，P<0.0001）。对于晚期毒性，纤维化（32%）和毛细血管扩张（14%）的发生率显著高于其他并发症（P<0.0001）。
与其他亚型相比，HER2富集亚型的疾病复发和生存失败显著增加。HER2阳性状态与LR发生率增加呈正相关。皮炎是最常见的急性RT相关毒性，纤维化是最常见的晚期RT相关毒性。
