乳腺导管内癌单纯保乳手术治疗与术后加用放疗对肿瘤复发的影响Meta分析  

The Influence of Breast- conserving Surgery with or without Radiotherapy on the Relapse of Ductal Carcinoma in Situ: A Meta Analysis

作　　者：许浩[1] 王家胜[1] 杨恒[1] 杨强[1] 

机构地区：[1]重庆医科大学附属永川医院普外科,重庆市402160

出　　处：《中国全科医学》2013年第30期3539-3543,共5页Chinese General Practice

摘　　要：目的评价在乳腺导管内癌(DCIS)治疗方面,单纯保乳手术后加用放疗与单纯保乳手术相比是否可以减少肿瘤复发。方法计算机检索PubMed、Embase、OVID、Cochrane Library、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库,全面搜集单纯保乳手术(对照组)和保乳手术后加用放疗(试验组)的临床对照试验,按Cochrane系统评价方法评价纳入研究质量,并使用RevMan 5.0软件进行Meta分析。结果最终纳入5项研究,包括4个随机对照试验,1个非随机对照试验。Meta分析结果显示,与对照组比较,试验组治疗后同侧肿瘤复发率降低〔RR=0.46,95%CI(0.39,0.54),P<0.00001〕。再分别对同侧非浸润性和浸润性肿瘤进行分析,发现试验组治疗后同侧非浸润性肿瘤复发率〔RR=0.47,95%CI(0.37,0.61),P<0.00001〕、同侧浸润性肿瘤复发率〔RR=0.45,95%CI(0.35,0.57),P<0.00001〕均较对照组降低。与对照组比较,试验组治疗后对侧乳腺肿瘤发生率增加〔RR=1.51,95%CI(1.05,2.18),P=0.03〕。两组乳腺肿瘤远处转移率间差异无统计学意义〔RR=1.05,95%CI(0.66,1.67),P=0.82〕。结论在保乳手术后加用放疗要比单纯的保乳手术治疗可以明显减少同侧肿瘤复发率,却增加了对侧肿瘤发生率,但肿瘤远处转移率间无差异。由于受纳入研究质量及样本量的限制,上述结论还有待高质量、大样本量的临床随机对照试验来证实。Objective In the treatment of ductal carcinoma in situ （ DCIS）, to investigate whether recurrence rate of breast - conserving surgery followed by radiotherapy is lower than that of pure breast conserving surgery. Methods We searched in the PubMed, Embase, OVID, Cochrane Library, CBM, CJFD and CSJD to identify studies on clinical controlled trials about breast -conserving surgery followed by radiotherapy （experimental group） and pure breast conserving surgery （control group）. The quality of the included studies was assessed by the Cochrane, and the data analyses were performed by the RevMan 5.0 software. Results Five studies were included, involving 4 randomized controlled trials （RCTs） and 1 non - RCTs. Meta analysis re- suits showed that the recurrence rate of ipsilateral breast cancer in experimental group was significantly lower than that in control group [RR =0. 46, 95% CI （0. 39, 0. 54）, P 〈0. 00001 ~ . Analysis was made to noninvasive and invasive breast cancer sep- arately, the recurrence rates of ipsilateral noninvasive and invasive breast cancer were significantly lower than those in control group [RR=0.47, 95%CI （0.37, 0.61）, P〈O. 00001; RR=0.45, 95%C1 （0.35, 0.57）, P〈0.00001] .The recurrence rate of contralateral breast cancer in experimental group was significantly higher than that in control group [ RR = 1.51, 95% Cl （ 1.05, 2. 18）, P = O. 03 . There was no significant difference in the rate of metastasis between the two groups [ RR = 1.05, 95 % CI （0. 66, 1.67 ）, P = 0. 82 ] . Conclusion The ipsilateral breast cancer recurrence rate of breast - conserving surgery followed by radiotherapy is significantly lower than that of pure breast conserving surgery, but contralateral breast cancer recurrence rate of breast - conserving surgery followed by radiotherapy is significantly higher than that of pure breast conserving surgery, there is no significant difference in the rate of metastasis between the two method. Due to the limitation of quality and sample size o

关 键 词：乳腺肿瘤 癌 导管 乳腺 放射治疗 保乳手术 复发 META分析 

分 类 号：R737.9[医药卫生—肿瘤]