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中华乳腺病杂志(电子版) ›› 2018, Vol. 12 ›› Issue (05) : 276 -281. doi: 10.3877/cma.j.issn.1674-0807.2018.05.004

所属专题: 文献

论著

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
吕文芝1, 丁波泥1,(), 钱立元1, 吴唯1, 文言广1   
  1. 1. 410013 长沙,中南大学湘雅三医院乳甲外科
  • 收稿日期:2018-02-26 出版日期:2018-10-01
  • 通信作者: 丁波泥

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

Wenzhi Lyu1, Boni Ding1,(), Liyuan Qian1, Wei Wu1, Yanguang Wen1   

  1. 1. Department of Breast and Thyroid Surgery, Third Xiangya Hospital of Central South University, Changsha 410013, China
  • Received:2018-02-26 Published:2018-10-01
  • Corresponding author: Boni Ding
  • About author:
    Corresponding author: Ding Boni, Email:
引用本文:

吕文芝, 丁波泥, 钱立元, 吴唯, 文言广. 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[J/OL]. 中华乳腺病杂志(电子版), 2018, 12(05): 276-281.

Wenzhi Lyu, Boni Ding, Liyuan Qian, Wei Wu, Yanguang Wen. Efficacy comparison of breast conserving surgery versus radical mastectomy in triple negative breast cancer patients: a meta-analysis[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2018, 12(05): 276-281.

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RevMan 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 of patients 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.

图1 文献筛选流程及结果
表1 纳入Mate分析的10篇文献质量评价(分)
表2 纳入Meta分析的10篇文献一般资料
图2 三阴性乳腺癌患者接受保乳术与乳房根治术后总生存率比较
图3 三阴性乳腺癌患者接受保乳术与乳房根治术后无瘤生存率比较
图4 三阴性乳腺癌患者接受保乳术与乳房根治术后无局部区域复发生存率比较
图5 三阴性乳腺癌患者接受保乳术与乳房根治术后OS比较的敏感性分析
图6 三阴性乳腺癌患者接受保乳术与乳房根治术后总生存率比较的论文发表偏倚漏斗图
图7 三阴性乳腺癌患者接受保乳术与乳房根治术后无局部区域复发生存率比较的论文发表偏倚漏斗图
[1]
陈万青,郑荣寿,张思维, 等. 2012年中国恶性肿瘤发病和死亡分析[J]. 中国肿瘤, 2016, 25(1): 1-8.
[2]
陈万青,郑荣寿,张思维, 等. 2013年中国恶性肿瘤发病和死亡分析[J]. 中国肿瘤, 2017, 26(1): 1-7.
[3]
Chen W,Zheng R,Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132.
[4]
Corbex M,Bouzbid S,Traverse-Glehen A, et al. Prevalence of papillomaviruses, polyomaviruses, and herpesviruses in triple-negative and inflammatory breast tumors from algeria compared with other types of breast cancer tumors[J]. PLoS One, 2014, 9(12): e114559.
[5]
李伟,王冰涛,尚宏清, 等. 保乳手术与改良根治术治疗早期乳腺癌的临床疗效比较[J]. 局解手术学杂志, 2014(1): 79-81.
[6]
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses [J]. Eur J Epidemiol, 2010, 25(9): 603-605.
[7]
Tierney JF,Stewart LA,Ghersi D, et al. Practical methods for incorporating summary time-to- event data into meta-analysis[J]. Trials, 2007, 8: 16.
[8]
Abdulkarim BS,Cuartero J,Hanson J, et al. Increased risk of locoregional recurrence for women with T1-2N0 triple-negative breast cancer treated with modified radical mastectomy without adjuvant radiation therapy compared with breast-conserving therapy [J]. J Clin Oncol, 2011, 29(21): 2852-2858.
[9]
Adkins FC,Gonzalez-Angulo AM,Lei X, et al. Triple-negative breast cancer is not a contraindication for breast conservation [J]. Ann Surg Oncol, 2011, 18(11): 3164-3173.
[10]
Chen L,Zhang J,Chen J, et al. Post-operative radiotherapy is beneficial for T1/T2 triple negative breast cancer patients with four or more positive lymph nodes [J]. Oncotarget, 2017, 8(26): 42 917-42 925.
[11]
Gabos Z,Thoms J,Ghosh S, et al. The association between biological subtype and locoregional recurrence in newly diagnosed breast cancer [J]. Breast Cancer Res Treat, 2010, 124(1): 187-194.
[12]
Ihemelandu CU,Naab TJ,Mezghebe HM, et al. Treatment and survival outcome for molecular breast cancer subtypes in black women [J]. Ann Surg, 2008, 247(3): 463-469.
[13]
Kindts I,Buelens P,Laenen A, et al. Omitting radiation therapy in women with triple-negative breast cancer leads to worse breast cancer-specific survival[J]. Breast, 2017, 32: 18-25.
[14]
Parker CC,Ampil F,Burton G, et al. Is breast conservation therapy a viable option for patients with triple-receptor negative breast cancer?[J]. Surgery, 2010, 148(2): 386-391.
[15]
Steward LT,Gao F,Taylor MA, et al. Impact of radiation therapy on survival in patients with triple-negative breast cancer [J]. Oncol Lett, 2014, 7(2): 548-552.
[16]
Voduc KD,Cheang MC,Tyldesley S, et al. Breast cancer subtypes and the risk of local and regional relapse[J]. J Clin Oncol, 2010, 28(10): 1684-1691.
[17]
Zumsteg ZS,Morrow M,Arnold B, et al. Breast-conserving therapy achieves locoregional outcomes comparable to mastectomy in women with T1-2N0 triple-negative breast cancer[J]. Ann Surg Oncol, 2013, 20(11): 3469-3476.
[18]
张保宁,张斌,唐中华, 等. 中国乳腺癌手术治疗10年的发展与变迁[J]. 中华肿瘤杂志, 2012, 34(8): 582-587.
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