Harris Christopher G, Azimi Farhad, Chan Belinda, Graham Susannah, Mak Cindy, Warrier Sanjay, Eslick Guy D
Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Department of Breast Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia.
Asia Pac J Clin Oncol. 2025 Apr;21(2):150-155. doi: 10.1111/ajco.14089. Epub 2024 May 29.
Metaplastic breast cancer is a rare aggressive subtype of breast cancer for which there are no clear treatment guidelines regarding the optimal surgical approach. This systematic review and meta-analysis aimed to evaluate survival outcomes of patients with metaplastic breast cancer undergoing breast conservation compared with mastectomy. We identified studies from MEDLINE, Pubmed, EMBASE, Google Scholar, the Cochrane Library Register of Controlled Trials and the EBM Reviews Register. Studies were deemed suitable for inclusion where they compared breast-conserving surgery to mastectomy with the primary outcome of overall survival. Survival data were pooled using a random-effects model. From the 456 citations screened by our search, three studies were assessed as eligible for inclusion. There were a total of 2995 patients who underwent mastectomy and 1909 who underwent breast conservation. The median follow-up time was 43 months. Meta-analysis demonstrated no significant difference between breast conservation and mastectomy (pooled HR 0.89, 95% CI, 0.56-1.42, p = 0.631). Wide local excision, in conjunction with adjuvant radiation and judicious use of chemotherapy, may be a reasonable alternative to mastectomy as surgical management of metaplastic breast cancer as part of an individualized, multidisciplinary approach.
化生性乳腺癌是一种罕见的侵袭性乳腺癌亚型，目前尚无关于最佳手术方式的明确治疗指南。本系统评价和荟萃分析旨在评估接受保乳手术与乳房切除术的化生性乳腺癌患者的生存结局。我们从MEDLINE、PubMed、EMBASE、谷歌学术、Cochrane对照试验图书馆注册库和循证医学评价注册库中检索研究。若研究将保乳手术与乳房切除术进行比较，并将总生存作为主要结局，则被认为适合纳入。生存数据采用随机效应模型进行汇总。在我们检索的456篇文献中，有三项研究被评估为符合纳入标准。共有2995例患者接受了乳房切除术，1909例患者接受了保乳手术。中位随访时间为43个月。荟萃分析表明，保乳手术与乳房切除术之间无显著差异（合并风险比0.89，95%可信区间0.56 - 1.42，p = 0.631）。作为化生性乳腺癌手术治疗的一部分，广泛局部切除联合辅助放疗及合理使用化疗，作为个体化多学科方法的一部分，可能是乳房切除术的合理替代方案。
