Morris A D, Morris R D, Wilson J F, White J, Steinberg S, Okunieff P, Arriagada R, Lê M G, Blichert-Toft M, van Dongen J A
Department of Radiation Oncology, Massachusetts, General Hospital, Boston 02114-2617, USA.
Cancer J Sci Am. 1997 Jan-Feb;3(1):6-12.
The randomized trials comparing breast-conserving therapy (BCT), i.e., surgery and radiation to the breast, with mastectomy in early-stage breast cancer use a variety of protocols. Meta-analysis may assist in understanding the impact of these differences on survival.
To evaluate the possible variations of the relative efficacy of BCT and mastectomy in terms of overall survival according to tumor size, nodal status, and use of adjuvant radiation therapy.
The most recent published results and, where available, updated patient-level data from randomized controlled trials of BCT and mastectomy for early-stage breast cancer were combined in a meta-analysis using a random effects model. Pooled survival rates and odds ratios were generated according to subgroups of nodal status and tumor size. Five- and 10-year odds ratios were also determined according to adjuvant radiation protocol.
The pooled odds ratio comparing 10-year survival for BCT and mastectomy was 0.91. The odds ratios comparing the two treatment regimens were not significant after grouping according to tumor size and nodal status. When more than 50% of node-positive patients in both the mastectomy and BCT arms received adjuvant radiation, both arms had similar survival rates. When less than 50% of node-positive patients in both arms received adjuvant nodal radiation, the odds ratio was 0.69, and patients receiving BCT had a survival advantage.
Patients allocated to BCT have survival rates at least as high as patients allocated to mastectomy. When all protocols were combined, nodal status and tumor size did not significantly alter the relative survival rates. However, under some conditions, particularly for node-positive patients, BCT may confer a relative survival advantage over mastectomy. In particular, mastectomy without adjuvant radiation appears to be inferior to BCT for node-positive patients.
比较保乳治疗（BCT），即对乳房进行手术和放疗，与早期乳腺癌乳房切除术的随机试验采用了多种方案。荟萃分析可能有助于理解这些差异对生存的影响。
根据肿瘤大小、淋巴结状态和辅助放疗的使用情况，评估BCT和乳房切除术在总生存方面相对疗效的可能差异。
将最近发表的结果以及（如有可用）早期乳腺癌BCT和乳房切除术随机对照试验的更新患者水平数据，采用随机效应模型进行荟萃分析合并。根据淋巴结状态和肿瘤大小亚组生成汇总生存率和比值比。还根据辅助放疗方案确定了5年和10年比值比。
比较BCT和乳房切除术10年生存的汇总比值比为0.91。根据肿瘤大小和淋巴结状态分组后，比较两种治疗方案的比值比无显著性差异。当乳房切除术组和BCT组中超过50%的淋巴结阳性患者接受辅助放疗时，两组生存率相似。当两组中少于50%的淋巴结阳性患者接受辅助淋巴结放疗时，比值比为0.69，接受BCT的患者具有生存优势。
分配接受BCT的患者生存率至少与分配接受乳房切除术的患者一样高。当所有方案合并时，淋巴结状态和肿瘤大小并未显著改变相对生存率。然而，在某些情况下，特别是对于淋巴结阳性患者，BCT可能比乳房切除术具有相对生存优势。特别是，对于淋巴结阳性患者，未进行辅助放疗的乳房切除术似乎不如BCT。
