Department of Breast Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China.
Department of Surgical Oncology, Taizhou Municipal Hospital, Taizhou, 318000, Zhejiang Province, China.
BMC Cancer. 2021 Jun 25;21(1):728. doi: 10.1186/s12885-021-08423-1.
It has been demonstrated that postmastectomy radiation therapy (PMRT) was beneficial for breast cancer patients who are axillary lymph node-positive. However, the effectiveness of radiotherapy in pathological negative nodes (ypN0) after neoadjuvant chemotherapy (NAC) remains open to considerable debate. Here, we aim to evaluate whether PMRT improves loco-regional control and survival for such patients.
The literature from January 2004 to June 2019 was searched. The effects of PMRT on local-regional recurrence (LRR) and survival was evaluated in a meta-analysis. Pooled relative risk (RR) values with 95% confidence intervals (CIs) were computed using random and fixed-effect model. Subgroup and heterogeneity analyses were also conducted.
Twelve studies that included 17,747 patients met the inclusion criteria. Pooled results showed that PMRT was associated with reduced LRR (RR, 0.38; 95% CI, 0.19-0.77, P = 0.007), particularly in patients with stage III breast cancer (RR, 0.16; 95% CI, 0.07-0.37, P < 0.001). However, no significant difference in disease-free survival were observed with the addition of PMRT for ypN0 patients (RR, 0.70; 95% CI, 0.21-2.27, P = 0.55). Also, there was no statistically significant association between radiotherapy with overall survival (RR, 0.81; 95% CI, 0.64-1.04, P = 0.10).
Our meta-analysis indicated that PMRT might reduce local-regional recurrence for ypN0 patients after NAC, but lack of benefit for survival outcomes. Prospective randomized clinical trial data will be needed to confirm our results.
已经证明，腋窝淋巴结阳性的乳腺癌患者接受乳房切除术和放疗（PMRT）是有益的。然而，新辅助化疗（NAC）后病理阴性淋巴结（ypN0）的放疗效果仍存在很大争议。在这里，我们旨在评估 PMRT 是否可以改善此类患者的局部区域控制和生存。
检索了 2004 年 1 月至 2019 年 6 月的文献。通过荟萃分析评估 PMRT 对局部区域复发（LRR）和生存的影响。使用随机和固定效应模型计算合并的相对风险（RR）值及其 95%置信区间（CI）。还进行了亚组和异质性分析。
符合纳入标准的有 12 项研究，共纳入 17747 例患者。汇总结果显示，PMRT 可降低 LRR（RR，0.38；95%CI，0.19-0.77，P=0.007），特别是对于 III 期乳腺癌患者（RR，0.16；95%CI，0.07-0.37，P<0.001）。然而，对于 ypN0 患者，添加 PMRT 并未显著改善无病生存率（RR，0.70；95%CI，0.21-2.27，P=0.55）。此外，放疗与总生存率之间也没有统计学上的显著关联（RR，0.81；95%CI，0.64-1.04，P=0.10）。
我们的荟萃分析表明，PMRT 可能降低 NAC 后 ypN0 患者的局部区域复发率，但对生存结果没有益处。需要前瞻性随机临床试验数据来证实我们的结果。
