腋窝淋巴结手术对Ⅳ期乳腺癌预后影响的Meta分析  

Effect of axillary lymph nodes surgery on the prognosis of stage Ⅳ breast cancer:a Meta-analysis

作　　者：赵玉洁 彭楠茜 吴明 陈波[1] ZHAO Yu-jie;PENG Nan-xi;WU Ming;CHEN Bo(Department of Breast Surgery,First Hospital Affiliated to China Medical University,Shenyang Liaoning 110001,China)

机构地区：[1]中国医科大学附属第一医院乳腺外科,辽宁沈阳110001

出　　处：《局解手术学杂志》2020年第12期979-984,共6页Journal of Regional Anatomy and Operative Surgery

基　　金：科技部十三五重点专项课题(410581610);辽宁省教育厅重点攻关和服务地方项目(ZF20190006)。

摘　　要：目的评估腋窝淋巴结(ALNs)手术对Ⅳ期乳腺癌患者预后的影响。方法在PubMed、Embase、the Cochrane Library、中国知网、万方数据库中系统检索Ⅳ期乳腺癌患者行ALNs手术的相关文献,检索时间为自建库至2020年5月。提取研究基本信息,纳入患者的基本信息,报告的生存数据如HR、95%CI、3年和5年生存率等。最终共纳入6项研究,包括20498例患者。使用固定效应模型或随机效应模型提取危险比(HR)、优势比(OR)和相关95%CI作为研究效应量,并进行亚组分析和敏感性分析。研究质量采用纽卡斯尔-渥太华量表(NOS)进行评估。结果相较于仅进行乳房手术的患者,接受ALNs手术尤其是腋窝淋巴结清扫(ALND)后的患者总生存率显著改善(HR=0.71,95%CI:0.52~0.95,P=0.02,I^2=94%);相较于仅进行乳房手术的患者,接受ALNs手术的患者病死率显著降低(OR=0.44,95%CI:0.40~0.48,P=0.00,I^2=39%)。结论与仅进行乳房手术相比,ALNs手术尤其是ALND可改善Ⅳ期乳腺癌患者的预后。Objective To evaluate the effect of axillary lymph nodes(ALNs)surgery on the prognosis of patients with stage Ⅳ breast cancer.Methods Literatures related to ALNs surgery for patients with stage Ⅳ breast cancer were systematically retrieved in databases of PubMed,Embase,the Cochrane Library,CNKI,and Wanfang from databases construction to May 2020.The basic information of those studies was extracted,the basic information of patients was included,and the survival data such as Hazard risk(HR),95%CI,3-year and 5-year survival rates were reported.A total of 6 studies were eventually included,including 20498 patients.HR,odds ratio(OR)and 95%CI were extracted as the research effect size by using fixed effects model or random effects model,and subgroup analysis and sensitivity analysis were carried out.The quality of this study was assessed by the Newcastle-Ottawa scale(NOS).Results Compared with patients who only underwent breast surgery,the overall survival of patients underwent ALNs surgery,especially axillary lymph nodes dissection(ALND),was significantly improved(HR=0.71,95%CI:0.52~0.95,P=0.02,I^2=94%).Compared with patients who only underwent breast surgery,the fatality rate of patients underwent ALNs surgery was significantly lower(OR=0.44,95%CI:0.40~0.48,P=0.00,I^2=39%).Conclusion Compared with breast surgery alone,ALNs surgery,especially ALND,can improve the prognosis of patients with stageⅣbreast cancer.

关 键 词：Ⅳ期乳腺癌 腋窝淋巴结 手术治疗 预后 META分析 转移性乳腺癌 原发性肿瘤切除 保乳手术 

分 类 号：R737.9[医药卫生—肿瘤] R619.9[医药卫生—临床医学]