Alghamdi Maha Ahmed Alamodi, Esam Mahmood Syed
Department of General Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia.
Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia.
Breast Cancer (Dove Med Press). 2023 May 9;15:349-358. doi: 10.2147/BCTT.S405864. eCollection 2023.
Metastatic breast cancer is difficult to cure and has a worse prognosis with higher rates of mortality. Recently, breast surgery is believed to improve the survival rates among these women, but due to limited evidence, definite conclusions cannot be made. Therefore, we undertook this narrative review to synthesize the evidence from existing studies to assess the effectiveness of locoregional surgery and surgery of metastatic sites in improving the outcomes among women diagnosed with metastatic cancer disease along with the summary of current treatment guidelines. We reviewed PubMed and Embase and included both observational studies and randomized controlled trials (RCTs) that were published in English between 2000 and 2021. Outcomes were either survival, quality of life, toxicity related to local treatment assessed by mortality at the end of one month, progression-free survival, and breast cancer-specific survival. The main effect size assessed was hazard ratio with their 95% CIs. After literature search, we found 8 observational studies and 3 RCTs. The findings of the observational studies revealed that breast cancer surgery improves survival from 30% to 50% among women. However, findings from RCTs were mixed for local and distant progression survival. Surgery improved the local progression-free survival but worsened the distant progression-free survival. Besides, there was no effect of breast surgery on quality of life. Regarding the surgery of metastatic site, studies are complex with mixed findings and variation in survival depending upon the type of metastatic site and response to initial systematic therapy and other factors. Based on the existing mixed evidence, it is not possible to make firm and definite conclusions about the effectiveness of breast surgery in improving the survival or quality of life among women with metastatic breast cancer. In future, more RCTs are required with a larger sample size to confirm the findings of observational studies.
转移性乳腺癌难以治愈，预后较差，死亡率较高。最近，人们认为乳房手术可提高这些女性的生存率，但由于证据有限，无法得出明确结论。因此，我们进行了这项叙述性综述，以综合现有研究的证据，评估局部区域手术和转移部位手术在改善转移性癌症女性患者预后方面的有效性，并总结当前的治疗指南。我们检索了PubMed和Embase，纳入了2000年至2021年期间以英文发表的观察性研究和随机对照试验（RCT）。结局指标为生存率、生活质量、与局部治疗相关的毒性（通过1个月末的死亡率评估）、无进展生存期和乳腺癌特异性生存期。评估的主要效应量为风险比及其95%置信区间。文献检索后，我们找到了8项观察性研究和3项RCT。观察性研究的结果显示，乳腺癌手术可使女性的生存率提高30%至50%。然而，RCT关于局部和远处进展生存期的结果不一。手术改善了局部无进展生存期，但恶化了远处无进展生存期。此外，乳房手术对生活质量没有影响。关于转移部位的手术，研究情况复杂，结果不一，生存期因转移部位类型、对初始系统治疗的反应及其他因素而异。基于现有的混合证据，无法就乳房手术在改善转移性乳腺癌女性患者的生存率或生活质量方面的有效性得出确凿无疑的结论。未来，需要更多样本量更大的RCT来证实观察性研究的结果。
