Sato Fumiya, Yamamoto Takumi
Department of Medical Education, National Center for Global Health and Medicine, Tokyo, Japan.
Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
J Plast Reconstr Aesthet Surg. 2022 Sep;75(9):2882-2889. doi: 10.1016/j.bjps.2022.06.046. Epub 2022 Jun 21.
A potentially fatal disease of breast angiosarcoma (AS) can occur after breast cancer treatments, and previous studies have revealed that lymphedema is a risk factor of AS development. However, little is known, and there is no systematic review focusing on the relationship between lymphedema and breast AS. This systematic review aimed to evaluate all publications on breast AS after primary breast cancer surgery to identify prognostic factors and evaluate treatment modalities.
Databases were searched for articles with published individual patient data on prognostic factors, treatment, and follow-up of patients with breast AS after primary breast cancer surgery. Statistical analysis was performed to test the prognostic values of age, gender, location, tumor-node-metastasis classification of primary breast cancer (tumor and node), stage of primary breast cancer, treatment for primary breast cancer, breast cancer recurrence, post-operative lymphedema, latent period from primary breast cancer to AS, treatment for AS, AS recurrence, and time until death or last follow-up.
Twenty articles were included, representing data on 41 patients. In these articles, 15 patients were referred to post-operative lymphedema. Eleven patients of them had post-operative lymphedema. As for this research, post-operative lymphedema was not a significant prognostic factor. AS recurrence was significant as a prognostic factor (P-value < 0.001) in univariate analysis for follow-up status; patients who had AS recurrence had a shorter time until death.
In this systematic review, AS recurrence was of prognostic value for breast AS patients after primary breast cancer surgery. There are only a few articles that refer post-operative breast lymphedema.
乳腺癌血管肉瘤（AS）是一种潜在致命性疾病，可发生于乳腺癌治疗后，既往研究显示淋巴水肿是AS发生的危险因素。然而，人们对淋巴水肿与乳腺AS之间的关系知之甚少，且尚无针对此关系的系统评价。本系统评价旨在评估所有关于原发性乳腺癌手术后乳腺AS的出版物，以确定预后因素并评估治疗方式。
检索数据库，查找有关原发性乳腺癌手术后乳腺AS患者预后因素、治疗及随访的已发表个体患者数据的文章。进行统计分析，以检验年龄、性别、部位、原发性乳腺癌的肿瘤-淋巴结-转移分类（肿瘤和淋巴结）、原发性乳腺癌分期、原发性乳腺癌治疗、乳腺癌复发、术后淋巴水肿、从原发性乳腺癌到AS的潜伏期、AS治疗、AS复发以及直至死亡或最后随访的时间等因素的预后价值。
纳入20篇文章，代表41例患者的数据。在这些文章中，15例患者提及术后淋巴水肿。其中11例患者存在术后淋巴水肿。就本研究而言，术后淋巴水肿不是一个显著的预后因素。在随访状态的单因素分析中，AS复发作为预后因素具有显著性（P值<0.001）；发生AS复发的患者直至死亡的时间较短。
在本系统评价中，AS复发对原发性乳腺癌手术后的乳腺AS患者具有预后价值。仅有少数文章提及术后乳腺淋巴水肿。
