Zheng Jianqing, Huang Bifen, Chen Ying, Chen Zhangzhu
Department of Radiation Oncology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China.
Department of Obstetrics and Gynecology, Quanzhou Medical College People's Hospital Affiliated, Quanzhou, Fujian, China.
Front Oncol. 2025 May 8;15:1489390. doi: 10.3389/fonc.2025.1489390. eCollection 2025.
Axillary management of patients with early-stage breast cancer (ESBC) has evolved, especially with the implementation of precision radiotherapy techniques that have resulted in a significant reduction in treatment-related toxicities, but it is unclear whether post-mastectomy radiotherapy (PMRT) improves survival outcomes in breast cancer with lymph nodes micrometastases (BCLNMM, that is T0, T1 ~2NmiM0). Our study is to systematically evaluate the effect of PMRT on survival in breast cancer with lymph nodes micrometastases.
A literature search was performed for randomized controlled trials (RCTs) or retrospective studies related to PMRT versus non-post-mastectomy radiotherapy (non-PMRT) in the adjuvant treatment of ESBC in PubMed, Cochrane Library, Embase, CNKI and other databases. R package software was used to perform meta-analyses with hazard ratio (HR). Newcastle Ottawa scale was selected for quality assessment. The review was prospectively registered on PROSPERO (CRD42024562444).
10 relevant studies were screened, all of which were retrospective studies. The difference in overall survival (OS) was not statistically significant (HR = 0.92, 95%CI: 0.81 ~ 1.04; Z = 1.35, = 0.177). The difference in breast cancer-specific survival (BCSS) between the PMRT group and the non-PMRT group was not statistically significant HR = 1.18, 95%CI: 0.94 ~ 1.48; Z = 1.41, =0.160). The difference in disease-free survival (DFS) was statistically significant (HR = 0.47, 95%CI: 0.23 ~ 1.00; Z = 1.96, =0.049). The difference in local recurrence free survival (LRRFS) was also not statistically significant (HR = 0.50, 95%CI: 0.11 ~ 2.26, = 0.190). The difference in distant-metastasis free survival (DMFS) was not statistically significant (HR = 0.54, 95%CI: 0.22 ~ 1.35, = 0.356).
Despite the tendency of PMRT in BCLNMM to improve DFS, OS, BCSS, LRRFS, and DMFS showed no benefit, therefore, PMRT should be used with caution in BCLNMM.
https://www.crd.york.ac.uk/prospero/, identifier CRD42024562444.
早期乳腺癌（ESBC）患者的腋窝处理方式已经发生了演变，尤其是精准放疗技术的应用显著降低了治疗相关毒性，但对于乳房切除术后放疗（PMRT）能否改善伴有淋巴结微转移的乳腺癌（BCLNMM，即T0、T1~2NmiM0）患者的生存结局尚不清楚。我们的研究旨在系统评估PMRT对伴有淋巴结微转移的乳腺癌患者生存的影响。
在PubMed、Cochrane图书馆、Embase、中国知网等数据库中检索与PMRT对比非乳房切除术后放疗（非PMRT）用于ESBC辅助治疗的随机对照试验（RCT）或回顾性研究。使用R包软件以风险比（HR）进行荟萃分析。选择纽卡斯尔渥太华量表进行质量评估。该综述已在PROSPERO（CRD42024562444）上进行前瞻性注册。
筛选出10项相关研究，均为回顾性研究。总生存（OS）差异无统计学意义（HR = 0.92，95%CI：0.811.04；Z = 1.35，P = 0.177）。PMRT组与非PMRT组之间的乳腺癌特异性生存（BCSS）差异无统计学意义（HR = 1.18，95%CI：0.941.48；Z = 1.41，P = 0.160）。无病生存（DFS）差异有统计学意义（HR = 0.47，95%CI：0.231.00；Z = 1.96，P = 0.049）。无局部复发生存（LRRFS）差异也无统计学意义（HR = 0.50，95%CI：0.112.26，P = 0.190）。无远处转移生存（DMFS）差异无统计学意义（HR = 0.54，95%CI：0.22~1.35，P = 0.356）。
尽管PMRT有改善BCLNMM患者DFS的趋势，但OS、BCSS、LRRFS和DMFS未显示出获益，因此，在BCLNMM患者中应谨慎使用PMRT。
