Guo Xuhui, Jiao Dechuang, Zhu Jiujun, Xiao Hui, Zhao Xin, Yang Yue, Zhao Yajie, Liu Zhenzhen
Department of Breast Disease, Henan Breast Cancer Center, The affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
Gland Surg. 2021 Apr;10(4):1447-1459. doi: 10.21037/gs-21-186.
Here, we carried out an extensive meta-analysis to investigate the effectiveness of the use of axillary reverse mapping (ARM) during axillary lymph node dissection (ALND) in preventing breast cancer-related lymphedema (BCRL).
Database searches to identify relevant randomized controlled trials (RCTs) were performed of MEDLINE (PubMed), Web of Science, Embase, and the Cochrane Library. Eligible articles with a publication date from database establishment to December 2020 were retrieved by combining keywords including: "breast cancer", "breast carcinoma", "breast neoplasm", "axillary reverse mapping", "axillary lymph node dissection", "lymphatic arm drainage", and "lymphedema". Independent data extraction was conducted, and Review Manager (version 5.3) was used for statistical analyses.
Five eligible RCTs were included in the meta-analysis. A total of 37 patients suffered arm lymphedema (37/786, 4.71%) in the experimental group (ARM during ALND), compared with 164 arm lymphedemas (164/873, 18.79%) in the control group (ALND alone). The results showed that ARM during ALND was superior to ALND alone in reducing the incidence of BCRL [OR =0.20, 95% confidence intervals (CI): 0.13-0.29, P<0.00001]; however, the 2 procedures did not differ significantly in terms of oncological safety or shoulder movement (OR =0.30, 95% CI: 0.03-2.96, P=0.30; OR =0.44, 95% CI: 0.14-1.40, P=0.17).
ARM during ALND can prevent and reduce the occurrence of BCRL in patients with early-stage BC during long-term follow-up. Due to the limited number of RCTs available, more in-depth, high-quality RCTs are urgently needed to provide a reliable and convincing basis for the application of ARM during ALND.
在此，我们进行了一项广泛的荟萃分析，以研究在腋窝淋巴结清扫术（ALND）期间使用腋窝反向映射（ARM）预防乳腺癌相关淋巴水肿（BCRL）的有效性。
对MEDLINE（PubMed）、科学网、Embase和Cochrane图书馆进行数据库检索，以识别相关的随机对照试验（RCT）。通过组合包括“乳腺癌”、“乳腺癌”、“乳腺肿瘤”、“腋窝反向映射”、“腋窝淋巴结清扫术”、“手臂淋巴引流”和“淋巴水肿”等关键词，检索从数据库建立到2020年12月发表的符合条件的文章。进行独立的数据提取，并使用Review Manager（5.3版）进行统计分析。
五项符合条件的RCT被纳入荟萃分析。实验组（ALND期间进行ARM）共有37例患者发生手臂淋巴水肿（37/786，4.71%），而对照组（仅进行ALND）有164例手臂淋巴水肿（164/873，18.79%）。结果表明，ALND期间进行ARM在降低BCRL发生率方面优于单纯ALND [比值比（OR）=0.20，95%置信区间（CI）：0.13 - 0.29，P<0.00001]；然而，这两种手术在肿瘤学安全性或肩部活动方面没有显著差异（OR =0.30，95% CI：0.03 - 2.96，P=0.30；OR =0.44，95% CI：0.14 - 1.40，P=0.17）。
ALND期间进行ARM可在长期随访中预防和减少早期乳腺癌患者BCRL的发生。由于可用的RCT数量有限，迫切需要更多深入、高质量的RCT，为ALND期间应用ARM提供可靠且有说服力的依据。
