Ding Fangjie, Zhao Junfeng, Wu Xue, Liu Xiaoman, Yang Yunxing, Li Ying, Qiao Lili, Zhang Yingying
Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan, Shandong, China.
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
J Cancer Res Ther. 2025 May 1;21(2):477-482. doi: 10.4103/jcrt.jcrt_1279_24. Epub 2025 May 2.
The necessity of postmastectomy radiotherapy (PMRT) following neoadjuvant chemotherapy (NAC) in patients with ypN0 breast cancer remains a controversial clinical issue. To elucidate this issue, the present study performed a systematic review and meta-analysis, focusing on studies of clinically lymph node-negative patients exhibiting a favorable pathologic response to NAC.
After a comprehensive literature search of PubMed and major oncology congress abstracts, 16 studies that met the inclusion criteria were included. A fixed or random effects model was used to assess the impact of PMRT on the local recurrence rate (LRR) and survival outcomes, where appropriate.
The pooled data from ten studies indicated that PMRT significantly reduced the LRR in patients with ypN0 breast cancer (risk ratio [RR], 0.52; 95% confidence interval [CI], 0.41-0.67, P < 0.00001). Moreover, a marginal increase in the overall survival (OS) rates was observed in nine studies (RR, 1.01; 95% CI, 1.00-1.02, P = 0.006), whereas no significant effect on disease-free survival (DFS) was found in six studies (RR, 1.01; 95% CI, 0.95-1.08, P = 0.72).
Our findings suggest that PMRT is associated with reduced LRR and slightly improved OS in patients with ypN0 breast cancer. However, prospective studies are needed to provide more evidence and inform clinical decision-making.
新辅助化疗（NAC）后ypN0乳腺癌患者进行乳房切除术后放疗（PMRT）的必要性仍是一个有争议的临床问题。为阐明这一问题，本研究进行了一项系统评价和荟萃分析，重点关注对NAC表现出良好病理反应的临床淋巴结阴性患者的研究。
在对PubMed和主要肿瘤学大会摘要进行全面文献检索后，纳入了16项符合纳入标准的研究。在适当情况下，使用固定或随机效应模型评估PMRT对局部复发率（LRR）和生存结果的影响。
来自10项研究的汇总数据表明，PMRT显著降低了ypN0乳腺癌患者的LRR（风险比[RR]，0.52；95%置信区间[CI]，0.41 - 0.67，P < 0.00001）。此外，9项研究中观察到总生存（OS）率略有增加（RR，1.01；95% CI，1.00 - 1.02，P = 0.006），而6项研究中未发现对无病生存（DFS）有显著影响（RR，1.01；95% CI，0.95 - 1.08，P = 0.72）。
我们的研究结果表明，PMRT与ypN0乳腺癌患者LRR降低和OS略有改善相关。然而，需要前瞻性研究提供更多证据并为临床决策提供参考。
