全乳切除术后放射治疗对前哨淋巴结微转移早期乳腺癌患者预后影响的Meta分析-东南大学学报医学版

全乳切除术后放射治疗对前哨淋巴结微转移早期乳腺癌患者预后影响的Meta分析

单位：1. 东南大学医学院, 江苏南京 210009;
2. 东南大学附属中大医院乳腺病诊疗中心, 江苏南京 210009

分类号：R737.9

出版年·卷·期（页码）：2024·43·第一期（97-104）

摘要：

目的: 荟萃文献,对比分析前哨淋巴结微转移早期乳腺癌患者全乳切除术后行与未行放射治疗的预后。方法: 检索中国生物医学文献数据库(China Biology Medicine,CBM)、中国期刊全文数据库(China National Knowledge Infrastructure,CNKI)、维普(VIP)、万方数据库、PubMed数据库、Embase数据库、Web of science(WOS)数据库、Cochrane数据库,由2名研究者各自独立对入选研究的有关试验设计、研究对象特征、研究结果等进行摘录,采用纽卡斯尔渥太华量表进行质量评价,采用Stata 17.0及Review Manager 5.4进行Meta分析。结果: 最终筛选出9篇相关文献,均为回顾性研究。中位随访30~98个月。术后放射治疗组与非放射治疗组乳腺癌特异性生存期(breast cancer-specific survival,BCSS)差异无统计学意义(HR=1.18,95%CI: 0.94~1.48,Z=1.43,P=0.15);两组无病生存期(disease-free survival,DFS)差异亦无统计学意义(HR=0.51,95%CI: 0.07~3.62,Z=-0.668,P=0.50);两组总生存期(overall survival,OS)差异亦无统计学意义(HR=1.02,95%CI: 0.93~1.12,Z=0.39,P=0.70)。结论: 前哨淋巴结微转移早期乳腺癌患者(T0、T1~2NmiM0)全乳切除术后予以放射治疗并不能改善患者的BCSS、DFS、OS。

Objective: To compare and analyze the prognosis of patients with early stage breast cancer with micro-metastases in the sentinel lymph nodes treated with post-mastectomy radiation therapy(PMRT)after mastectomy and without PMRT. Methods: China Biology Medicine(CBM),China National Knowledge Infrastructure(CNKI),China Science and Technology Journal Database,Wanfang database,PubMed database,Embase database,Web of science(WOS) database,and Cochrane library. The screening was independently performed by two researchers according to the inclusion and exclusion criteria,extracting data,assessing methodological quality,and analyzing results were achieved. Stata 17.0 and Review Manager 5.4 software were applied for Meta-analysis. Results: A total of nine retrospective studies were included,with a median follow-up of 30 to 98 months. Meta-analysis showed that the PMRT after mastectomy did not significantly improve the breast cancer-specific survival(BCSS)(HR=1.18,95%CI:0.94-1.48,Z=1.43,P=0.15),disease-free survival(DFS)(HR=0.51,95%CI:0.07-3.62,Z=-0.668,P=0.50),and overall survival(OS)(HR=1.02,95%CI:0.93-1.12,Z=0.39,P=0.70) in the early-stage breast cancer with sentinel lymph node micro-metastasis.Conclusion: For patients with early-stage breast cancer and micro-metastases in the sentinel lymph nodes(T0,T1-2NmiM0),PMRT after mastectomy does not improve BCSS,DFS,and OS.

参考文献：

[1] ANAMPA J,MAKOWER D,SPARANO J A.Progress in adjuvant chemotherapy for breast cancer:an overview[J].BMC Med,2015,13:195.
[2] GIULIANO A E,HUNT K K,BALLMAN K V,et al.Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis:a randomized clinical trial[J].JAMA,2011,305(6):569-575.
[3] HANSEN N M,GRUBE B,YE X,et al.Impact of micrometastases in the sentinel node of patients with invasive breast cancer[J].Clin Oncol,2009,27(28):4679-4684.
[4] IMOTO S,OCHIAI A,OKUMURA C,et al.Impact of isolated tumor cells in sentinel lymph nodes detected by immunohistochemical staining[J].Eur J Surg Oncol,2006,32(10):1175-1179.
[5] DE BOER M,VAN DEURZEN C H,VAN DIJCK J A,et al.Micrometastases or isolated tumor cells and the outcome of breast cancer[J].N Engl J Med,2009,361(7):653-663.
[6] GALIMBERTI V,COLE B F,VIALE G,et al.Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases(IBCSG 23-01):10-year follow-up of a randomised,controlled phase 3 trial[J].Lancet Oncol,2018,19(10):1385-1393.
[7] SOLÁ M,ALBERRO J A,FRAILE M,et al.Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis:final results from the multicenter clinical trial AATRM 048/13/2000[J].Ann Surg Oncol,2013,20(1):120-127.
[8] HOUVENAEGHEL G,SABATIER R,REYAL F,et al.Axillary lymph node micrometastases decrease triple-negative early breast cancer survival[J].Br J Cancer,2016,115(9):1024-1031.
[9] SUSNIK B,FRKOVIC-GRAZIO S,BRACKO M.Occult micrometastases in axillary lymph nodes predict subsequent distant metastases in stage I breast cancer:a case-control study with 15-year follow-up[J].Ann Surg Oncol,2004,11(6):568-572.
[10] ANDERSSON Y,BERGKVIST L,FRISELL J,et al.Long-term breast cancer survival in relation to the metastatic tumor burden in axillary lymph nodes[J].Breast Cancer Res Treat,2018,171(2):359-369.
[11] SALHAB M,PATANI N,MOKBEL K.Sentinel lymph node micrometastasis in human breast cancer:an update[J].Surg Oncol,2011,20(4):e195-e206.
[12] MCGALE P,TAYLOR C,CORREA C,et al.Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality:meta-analysis of individual patient data for 8135 women in 22 randomised trials[J].Lancet,2014,383(9935):2127-2135.
[13] WELLS G A,SHEA B,O'CONNELL D.The Newcastle-Ottawa Scale(NOS) for assessing the quality of nonrandomised studies in meta-analyses[EB/OL].http://www.ohri.ca/programs/clinical-epidemiology/oxford.asp,2012.
[14] LUO H,YANG O O,HE J L,et al.Impact of post-mastectomy radiation therapy for sentinel lymph node micrometastases in early-stage breast cancer patients[J].Med Sci Monit,2022,28:e933275.
[15] LIM S Z,KUSUMAWIDJAJA G,ISHAK H M M,et al.Outcomes of stage Ⅰ and Ⅱ breast cancer with nodal micrometastases treated with mastectomy without axillary therapy[J].Breast Cancer Res Treat,2021,189(3):837-843.
[16] SHI J,LIAN C L,CHI F,et al.Prognostic and predictive value of the American Joint Committee on Cancer Pathological Prognostic Staging System in nodal micrometastatic breast cancer[J/OL].Front Oncol,2020,10:570175.doi:10.3389/fonc.2020.570175.eCollection 2020.
[17] PATEL M A,LI C H,ARONSON J H,et al.The effect of post mastectomy radiation therapy on survival in breast cancer patients with N1mic disease[J].Breast,2020,51:50-56.
[18] ZHANG W W,TONG Q,SUN J Y,et al.21-Gene Recurrence Score Assay could not predict benefit of post-mastectomy radiotherapy in T1-2 N1mic ER-positive HER2-negative breast cancer[J].Front Oncol,2019,9:270.
[19] WU S P,TAM M,SHAIKH F,et al.Post-mastectomy radiation therapy in breast cancer patients with nodal micrometastases[J].Ann Surg Oncol,2018,25(9):2620-2631.
[20] EASTWICK G,DAUGHERTY M,BOGART J,et al.Postmastectomy radiation leads to increased mortality in patient with nodal micrometastasis[J].Radiother Oncol,2018,127:S382-S383.
[21] PICADO O,KHAZENI K,ALLEN C,et al.Extent of regional lymph node surgery and impact on outcomes in patients with early-stage breast cancer and limited axillary disease undergoing mastectomy[J].Breast Cancer Res Treat,2018,171(2):461-469.
[22] CHANG J S,LEE J,KIM K H,et al.Do recent advances in diagnostic and therapeutic procedures negate the benefit of postmastectomy radiotherapy in N1 patients with a low risk of locoregional recurrence?[J].Medicine(Baltimore),2015,94(33):e1259.
[23] ZHOU Y,PU S,JIANG S,et al.The prognostic significance of further axillary dissection for sentinel lymph node micrometastases in female breast cancer:a competing risk analysis using the SEER database[J].Front Oncol,2022,12:1012646.
[24] CHEN F,LI X,LIN X,et al.Can axillary lymph node dissection be omitted in breast cancer patients with metastatic sentinel lymph nodes undergoing mastectomy? A systematic review and Meta-analysis of real-world evidence[J].World J Surg,2023,47(10):2446-2456.
[25] VASILJEVIC D,ARNOLD C,NEUMAN D,et al.Occurrence of pneumonitis following radiotherapy of breast cancer-a prospective study[J].Strahlenther Onkol,2018,194(6):520-532.
[26] NOLAN E,BRIDGEMAN V L,OMBRATO L,et al.Radiation exposure elicits a neutrophil-driven response in healthy lung tissue that enhances metastatic colonization[J].Nat Cancer,2022,3(2):173-187.
[27] MAMTANI A,PATIL S,STEMPEL M,et al.Axillary micrometastases and isolated tumor cells are not an indication for post-mastectomy radiotherapy in stage 1 and 2 breast cancer[J].Ann Surg Oncol,2017,24(8):2182-2188.
[28] FITZSULLIVAN E,BASSETT R L,KUERER H M,et al.Outcomes of sentinel lymph node-positive breast cancer patients treated with mastectomy without axillary therapy[J].Ann Surg Oncol,2017,24(3):652-659.

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