比较有和无完成腋窝淋巴结清扫的前哨淋巴结转移早期乳腺癌患者：系统评价和荟萃分析。
Comparing Early-Stage Breast Cancer Patients with Sentinel Lymph Node Metastasis with and without Completion Axillary Lymph Node Dissection: A Systematic Review and Meta-Analysis.
机构信息
Department of General Surgery, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.
Research Center for Health Technology Assessment and Medical Informatics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
出版信息
Asian Pac J Cancer Prev. 2022 Aug 1;23(8):2561-2571. doi: 10.31557/APJCP.2022.23.8.2561.
BACKGROUND
Currently, the standard method for staging and treatment of axillary lymph nodes for early-stage breast cancer is sentinel lymph node biopsy (SLNB), while axillary lymph node dissection (ALND) is used in cases with palpable axillary lymph nodes or positive SLNB cases. The aim of this review was to compare overall survival (OS), disease-free survival (DFS), and axillary recurrence in early-stage breast cancer patients underwent SLNB or SLNB and completion ALND.
METHODS
The databases of PubMed, Scopus, and Cochrane Library were searched using the key words of "breast cancer", "axillary lymph node dissection", and "sentinel lymph node dissection". In addition, other sources were searched for ongoing studies (i.e., clinicaltrials.gov). The clinical trials were evaluated based on the Jadad quality criteria, and cohort studies were evaluated according to the STROBE criteria. At the end of the search, the articles were screened independently by two reviewers to check their eligibility to be included in the study. Afterwards, the data were extracted independently by two researchers.
RESULTS
After searching the databases, 169 papers were retrieved. However, after removing the duplicates and studying the titles and abstracts of these papers, only ten ones underwent further investigation. After reading full-text of each article, four studies were finalized. Following a manual search, 27 papers were entered into the study for the final evaluation, 11 of which were included in the meta-analysis based on the inclusion and exclusion criteria. The findings showed no significant differences in OS, DFS, and axillary recurrence in early-stage breast cancer patients underwent SLNB or SLNB and completion ALND.
CONCLUSION
The findings did not confirm that ALND improved OS, DFS, and axillary recurrence in patients who were clinically node-negative and positive SLNB.
背景
目前，早期乳腺癌腋窝淋巴结分期和治疗的标准方法是前哨淋巴结活检（SLNB），而腋窝淋巴结清扫术（ALND）用于可触及腋窝淋巴结或 SLNB 阳性的病例。本综述的目的是比较早期乳腺癌患者接受 SLNB 或 SLNB 加完成 ALND 的总生存率（OS）、无病生存率（DFS）和腋窝复发情况。
方法
使用“乳腺癌”、“腋窝淋巴结清扫术”和“前哨淋巴结活检术”等关键词在 PubMed、Scopus 和 Cochrane 图书馆数据库中进行检索。此外，还搜索了其他正在进行的研究（即 clinicaltrials.gov）。根据 Jadad 质量标准评估临床试验，根据 STROBE 标准评估队列研究。在搜索结束时，由两名评审员独立筛选文章，以检查其是否符合纳入研究的标准。然后，由两名研究人员独立提取数据。
结果
在数据库中搜索后，共检索到 169 篇论文。但是，在去除重复项并研究这些论文的标题和摘要后，只有 10 篇论文进一步进行了研究。在阅读了每篇文章的全文后，最终确定了四项研究。经过手动搜索，共有 27 篇论文进入研究进行最终评估，其中 11 篇根据纳入和排除标准纳入荟萃分析。研究结果表明，在接受 SLNB 或 SLNB 加完成 ALND 的早期乳腺癌患者中，OS、DFS 和腋窝复发无显著差异。
结论
这些发现并不能证实在临床淋巴结阴性和 SLNB 阳性的患者中，ALND 能改善 OS、DFS 和腋窝复发。
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