Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada; Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China.
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Br J Anaesth. 2020 Sep;125(3):346-357. doi: 10.1016/j.bja.2020.04.088. Epub 2020 Jun 28.
The prevalence and intensity of persistent post-surgical pain (PPSP) after breast cancer surgery are uncertain. We conducted a systematic review and meta-analysis to further elucidate this issue.
We searched MEDLINE, Embase, CINAHL, and PsycINFO, from inception to November 2018, for observational studies reporting persistent pain (≥3 months) after breast cancer surgery. We used random-effects meta-analysis and the Grading of Recommendations, Assessment, Development and Evaluations approach to rate quality of evidence.
We included 187 observational studies with 297 612 breast cancer patients. The prevalence of PPSP ranged from 2% to 78%, median 37% (inter-quartile range: 22-48%); the pooled prevalence was 35% (95% confidence interval [CI]: 32-39%). The pooled pain intensity was 3.9 cm on a 10 cm visual analogue scale (95% CI: 3.6-4.2 cm). Moderate-quality evidence supported the subgroup effects of PPSP prevalence for localized pain vs any pain (29% vs 44%), moderate or greater vs any pain (26% vs 44%), clinician-assessed vs patient-reported pain (23% vs 36%), and whether patients underwent sentinel lymph node biopsy vs axillary lymph node dissection (26% vs 43%). The adjusted analysis found that the prevalence of patient-reported PPSP (any severity/location) was 46% (95% CI: 36-56%), and the prevalence of patient-reported moderate-to-severe PPSP at any location was 27% (95% CI: 10-43%).
Moderate-quality evidence suggests that almost half of all women undergoing breast cancer surgery develop persistent post-surgical pain, and about one in four develop moderate-to-severe persistent post-surgical pain; the higher prevalence was associated with axillary lymph node dissection. Future studies should explore whether nerve sparing for axillary procedures reduces persistent post-surgical pain after breast cancer surgery.
乳腺癌手术后持续性术后疼痛（PPSP）的发生率和强度尚不确定。我们进行了系统评价和荟萃分析，以进一步阐明这一问题。
我们检索了 MEDLINE、Embase、CINAHL 和 PsycINFO 数据库，从建库至 2018 年 11 月，以获取报告乳腺癌手术后持续性疼痛（≥3 个月）的观察性研究。我们使用随机效应荟萃分析和推荐评估、制定与评价（GRADE）方法对证据质量进行评级。
我们纳入了 187 项观察性研究，共 297612 例乳腺癌患者。PPSP 的发生率为 2%至 78%，中位数为 37%（四分位距：22-48%）；汇总发生率为 35%（95%置信区间：32-39%）。汇总疼痛强度为 10cm 视觉模拟评分法（VAS）上的 3.9cm（95%置信区间：3.6-4.2cm）。中等质量证据支持 PPSP 发生率的亚组效应，局部疼痛与任何疼痛（29%比 44%）、中度或更剧烈疼痛与任何疼痛（26%比 44%）、临床医生评估与患者报告的疼痛（23%比 36%）以及行前哨淋巴结活检与腋窝淋巴结清扫术（26%比 43%）。调整分析发现，患者报告的 PPSP（任何严重程度/部位）发生率为 46%（95%置信区间：36-56%），任何部位中度至重度 PPSP 的发生率为 27%（95%置信区间：10-43%）。
中等质量证据表明，几乎一半接受乳腺癌手术的女性会出现持续性术后疼痛，约四分之一会出现中重度持续性术后疼痛；更高的发生率与腋窝淋巴结清扫术相关。未来的研究应探讨腋窝手术时行神经保护是否能降低乳腺癌手术后的持续性术后疼痛。
