保留乳房手术对比乳房根治术治疗三阴性乳腺癌疗效的Meta分析  

Efficacy comparison of breast conserving surgery versus radical mastectomy in triple negative breast cancer patients:a meta-analysis

作　　者：吕文芝 丁波泥[1] 钱立元[1] 吴唯[1] 文言广[1] Lyu Wenzhi;Ding Boni;Qian Liyuan;Wu Wei;Wen Yanguang(Department of Breast and Thyroid Surgery,Third Xiangya Hospital of Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院乳甲外科,长沙410013

出　　处：《中华乳腺病杂志（电子版）》2018年第5期276-281,共6页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：目的评价保留乳房手术(简称保乳术)和乳房根治术对三阴性乳腺癌患者预后的影响。方法通过PubMed、Embase、MEDLINE、中国知网、维普和万方数据库,收集符合要求的队列研究。由2位评价员按照纳入与排除标准独立筛选文献、提取资料[病例数、生存曲线、风险比(HR)等],并运用改良纽卡斯尔-渥太华量表(NOS)对文章的质量进行系统评价。若文中未提及HR,则运用Engauge Digitizer 6. 2软件提取各研究中生存曲线的数据,再计算出乳房根治术和保乳术患者OS率、DFS率以及无局部区域复发生存率(LRRFS)的ln(HR)和se[ln(HR)];若文中提及HR,则直接计算出ln(HR)和se[ln(HR)]。最后统一使用Rev Man 5. 3软件对研究数据进行Meta分析。结果最终纳入符合标准的相关文献10篇,累计样本量5 487例患者。NOS评价结果显示,所有纳入文献评分为7～9分,均为质量较高的文献。Meta分析显示,在三阴性乳腺癌的队列研究中,保乳术患者OS率明显高于乳房根治术者(HR=1. 25,95%CI:1. 09～1. 44,P=0. 001)。而保乳术与乳房根治术相比,患者DFS率和无局部区域复发生存(LRRFS)率的差异均无统计学意义(HR=0. 97,95%CI:0. 72～1. 30,P=0. 830; HR=1. 11,95%CI:0. 93～1. 34,P=0. 250)。结论三阴性乳腺癌患者行保乳术的OS率优于乳房根治术,因此,满足保乳术指征的患者应该尽量选择保乳术。Objective To evaluate the effect of breast conserving surgery （BCS） versus radical mastectomy on the prognosis of triple negative breast cancer （TNBC） patients.Methods The databases （PubMed, Embase, MEDLINE, CNKI, VIP, WanFang） were searched for the related studies that met the requirements. Two reviewers independently screened the literature and extracted the data, such as number of cases, survival curve, hazard ratio （ HR ）. The methodological quality of included studies was accessed using the Newcastle-Ottawa Scale （NOS）. If HR was not mentioned in the papers, Engauge Digitizer 6.2 software was used to extract the survival curve data of each study, and then the ln（ HR ） and se[ln（ HR ）] of mastectomy versus BCS in the OS, DFS and local-regional recurrence-free survival （LRRFS） were calculated. If HR was mentioned in the papers, the ln（ HR ） and se[ln（ HR ）] were calculated directly. Finally, a meta-analysis was performed using RevMan 5.3 software.Results Totally 10 eligible studies were included, with 5 487 triple negative breast cancer patients involved. The NOS scores of all included studies were 7-9, indicating high methodological quality. In 10 cohort studies of TNBC, the OS of patients receiving BCS was significantly higher than that ofpatients receiving radical mastectomy （ HR =1.25,95% CI ：1.09-1.44, P =0.001）.The DFS （ HR =0.97,95% CI ：0.72-1.30, P =0.830） and LRRFS （ HR =1.11,95% CI ：0.93-1.34, P =0.250） presented no significant difference between two groups.Conclusion In TNBC, BCS was superior to mastectomy in the OS, so BCS is recommended to the patients who meet the indications.

关 键 词：乳腺肿瘤 手术 无病生存 META分析 总生存 无局部区域复发生存 三阴性乳腺癌 

分 类 号：R737.9[医药卫生—肿瘤]