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中华乳腺病杂志(电子版) ›› 2026, Vol. 20 ›› Issue (01) : 34 -43. doi: 10.3877/cma.j.issn.1674-0807.2026.01.005

论著

乳腺癌放射治疗患者放射性皮炎发生率及影响因素的Meta分析
李荣, 肖正权, 王龙, 张欢()   
  1. 400030 重庆,重庆大学附属肿瘤医院乳腺肿瘤中心
  • 收稿日期:2025-01-06 出版日期:2026-02-01
  • 通信作者: 张欢
  • 基金资助:
    重庆市自然科学基金(2024NSCQ-MSX1087); 重庆市科卫联合(2023MSXM103); 重庆市沙坪坝区技术创新项目(2024149)

Incidence of radiation dermatitis and influencing factors in breast cancer patients undergoing radiotherapy: a meta-analysis

Rong Li, Zhengquan Xiao, Long Wang, Huan Zhang()   

  1. Breast Cancer Center, Cancer Hospital of Chongqing University, Chongqing 400030, China
  • Received:2025-01-06 Published:2026-02-01
  • Corresponding author: Huan Zhang
引用本文:

李荣, 肖正权, 王龙, 张欢. 乳腺癌放射治疗患者放射性皮炎发生率及影响因素的Meta分析[J/OL]. 中华乳腺病杂志(电子版), 2026, 20(01): 34-43.

Rong Li, Zhengquan Xiao, Long Wang, Huan Zhang. Incidence of radiation dermatitis and influencing factors in breast cancer patients undergoing radiotherapy: a meta-analysis[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2026, 20(01): 34-43.

目的

系统评价乳腺癌放射治疗患者放射性皮炎(RD)的发生率及影响因素。

方法

计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Embase、Web of Science、OVID、CINAHL和Cochrane Library中乳腺癌放射治疗患者RD发生率及其影响因素的相关研究进行Meta分析,检索时间范围为建库起至2024年12月。由2名研究者独立进行文献筛选、质量评价和资料整理,采用RevMan 5.4与Stata 15.0软件进行统计分析。

结果

最终纳入33篇文献,其中24篇报道了乳腺癌患者RD的发生率,纳入8 696例乳腺癌患者。Meta分析结果显示,乳腺癌患者在接受放射治疗期间RD的总体发生率为82%(95%CI:69%~91%)。加强照射(OR=1.49,95%CI:1.22~1.83,P<0.001)、较大的乳房体积(OR=1.10,95%CI:1.04~1.16,P<0.001)、体质量指数≥25 kg/m2OR=1.29,95%CI:1.11~1.51,P<0.001)、常规分割放射治疗方式(OR=1.97,95%CI:1.33~2.94,P<0.001)、吸烟(OR=1.58,95%CI:1.00~2.50,P=0.050)、糖尿病(OR=1.47,95%CI:1.12~1.95,P<0.05)、放射治疗前化疗(OR=1.25,95%CI:1.06~1.47,P<0.05)和使用补偿膜(OR=3.53,95%CI:2.74~4.55,P<0.001)是乳腺癌放射治疗患者发生RD的危险因素;而高血压(OR=1.16,95%CI:0.82~1.66,P=0.550)和年龄(OR=1.02,95%CI:0.99~1.04,P=0.230)不是乳腺癌放射治疗患者发生RD的危险因素。

结论

乳腺癌放射治疗患者RD发生率较高,受多种因素影响,其中加强照射、较大的乳房体积、体质量指数≥25 kg/m2、常规分割放射治疗方式、吸烟、糖尿病、放射治疗前化疗和使用补偿膜增加了RD的发生风险。

Objective

To systematically evaluate the incidence and influencing factors of radiation dermatitis (RD) in breast cancer patients treated with radiotherapy.

Methods

A meta-analysis was conducted on the incidence of RD and its influencing factors in breast cancer patients receiving radiotherapy in the CNKI, Wanfang Database, VIP Database, Chinese Biomedical Literature Database, PubMed, Embase, Web of Science, OVID, CINAHL and Cochrane Library, and the time range was from the establishment of the database to December 2024. Two researchers independently conducted literature screening, quality evaluation and data collation, and used RevMan 5.4 and Stata 15.0 software for statistical analysis.

Results

A total of 33 articles were included, of which 24 articles reported the incidence of RD in 8 696 breast cancer patients receiving radiotherapy and the overall incidence of RD was 82% (95%CI: 69%-91%). Intensive irradiation (OR=1.49, 95%CI: 1.22-1.83, P<0.001), large breast volume (OR=1.10, 95%CI: 1.04-1.16, P<0.001), body mass index ≥25 kg/m2 (OR=1.29, 95%CI: 1.11-1.51, P<0.001), conventional fractionated radiotherapy (OR=1.97, 95%CI: 1.33-2.94, P<0.001), smoking (OR=1.58, 95%CI: 1.00-2.50, P=0.050), diabetes (OR=1.47, 95%CI: 1.12-1.95, P<0.05), chemotherapy before radiotherapy(OR=1.25, 95%CI: 1.06-1.47, P<0.05), and use of compensation membranes (OR=3.53, 95%CI: 2.74-4.55, P<0.001) were risk factors for RD in patients undergoing radiotherapy for breast cancer. However, the results of this study could not support hypertension (OR=1.16, 95%CI: 0.82-1.66, P=0.550) and age (OR=1.02, 95%CI: 0.99-1.04, P=0.230) as the risk factors for RD in breast cancer patients with radiotherapy.

Conclusion

The incidence of RD in breast cancer patients undergoing radiotherapy is high due to various factors, among which intensified irradiation, large breast volume, body mass index ≥25 kg/m2, conventional fractionated radiotherapy, smoking, diabetes, chemotherapy before radiotherapy and use of compensatory membranes increase the risk of RD.

图1 文献筛选流程图
表1 纳入研究的基本特征与质量评价
研究者 国家 发表时间 研究设计类型 例数 调查工具 涉及的影响因素 文献等级
Abdeltawab等8 埃及 2021 横断面研究 75 RTOG/EORTC
Córdoba等9 埃及 2021 横断面研究 122 RTOG ②③⑥⑦⑧
Dzul等10 美国 2021 病例对照研究 272 CTCAE ①②③④⑩
Behroozian等11 加拿大 2021 横断面研究 1 093 CTCAE ①③④⑨
Borm等12 德国 2018 横断面研究 255 CTCAE
Liu等13 中国 2022 队列研究 598 RTOG
Xie等14 中国 2023 队列研究 455 ONS ③⑤⑥⑦⑧⑩
耿文慧等15 中国 2023 横断面研究 106 RTOG
Pasquier等16 法国 2021 队列研究 288 CTCAE
Chen等17 中国 2020 队列研究 308 RTOG
Pasquier等18 法国 2019 横断面研究 114 CTCAE ③⑧
Butler-Xu等19 美国 2018 队列研究 114 RTOG
Zygogianni等20 德国 2020 队列研究 134 RTOG/EORTC
Palumbo等21 意大利 2019 队列研究 219 CTCAE ①⑧
Lin等22 中国 2018 队列研究 458 CTCAE
Guttmann等23 美国 2018 队列研究 413 CTCAE ①④
De Felice等24 意大利 2017 队列研究 120 CTCAE ②④⑧
Córdoba等25 美国 2016 横断面研究 80 RTOG ②③
Pignol等26 加拿大 2015 队列研究 257 CTCAE ⑤⑧⑨
Jagsi等27 美国 2015 队列研究 2 309 CTCAE
Wright等28 美国 2014 队列研究 110 CTCAE ③⑤⑧⑩
Park等29 韩国 2014 横断面研究 213 RTOG
Ciammella等30 意大利 2014 横断面研究 212 RTOG ①②
Tortorelli等31 意大利 2013 队列研究 339 RTOG ④⑧⑩
Terrazzino等32 意大利 2012 横断面研究 286 RTOG ①②
Morganti等33 意大利 2009 队列研究 332 RTOG ④⑤⑥⑦⑧
Freedman等34 美国 2009 队列研究 804 CTCAE ②⑧
Back等35 德国 2004 横断面研究 223 CTCAE
Fernando等36 英国 1996 队列研究 197 急性皮肤反应评分系统
Ambrosone等37 德国 2006 病例对照研究 446 CTCAE
Wright等38 美国 2016 队列研究 392 改良评级量表、CTCAE ③④⑩
张顺康等39 中国 2015 队列研究 786 CTCAE ③⑦⑧⑨
Patel等40 美国 2018 横断面研究 502 CTCAE ③⑩
图2 乳腺癌患者放射性皮炎发生率森林图
表2 乳腺癌患者放射性皮炎发生率亚组分析
图3 乳腺癌患者发生放射性皮炎影响因素的森林图 A图为加强照射对乳腺癌患者发生RD的影响;B图为较大的乳房体积对乳腺癌患者发生RD的影响;C图为BMI≥25 kg/m2对乳腺癌患者发生RD的影响;D图图为常规分割放射治疗对乳腺癌患者发生RD的影响;E图为吸烟对乳腺癌患者发生RD的影响;F图为高血压对乳腺癌患者发生RD的影响;G图为糖尿病对乳腺癌患者发生RD的影响;H图为放射治疗前化疗对乳腺癌患者发生RD的影响;I图为使用补偿膜对乳腺癌患者发生RD的影响;J图为年龄对乳腺癌患者发生RD的影响 注:RD为放射性皮炎
图4 乳腺癌患者放射性皮炎发生率敏感性分析
图5 乳腺癌患者放射性皮炎发生率漏斗图
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