前哨淋巴结微转移与乳腺癌复发风险的系统评价及Meta分析
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摘要
目的系统评价在未行腋窝淋巴结清扫时,前哨淋巴结(SLN)微转移对乳腺癌患者复发相关事件发生率(RRER)的影响。方法检索PubMed、EMBASE、WanFang数据、CNKI、CBM建库至2018年5月1日的文献资料,严格按照纳入和排除标准筛选相关研究,对纳入的研究进行资料提取,采用NOS量表进行质量评价,使用RevMan 5.2软件进行Meta分析。结果最终筛选出6篇相关文献共1 730例患者,其中3项前瞻性观察研究,3项回顾性研究。中位随访33～77个月,SLN微转移组(370例)与SLN阴性组(1 360例)的RRER差异无统计学意义(OR=1.37,95%CI:0.72～2.59,I~2=47%,P=0.34);同时,在局部复发率方面,SLN微转移组354例,复发12例,SLN阴性组1 337例,复发35例,两者比较差异亦无统计学意义(OR=1.49,95%CI:0.75～2.97,I2=40%,P=0.26)。结论 SLN微转移并不增加乳腺癌患者的复发风险。
Objective To systemically evaluate the recurrence related event rate(RRER) of breast cancer with sentinel lymph node micrometastasis(SLN MIC) without axillary lymph node dissection(ALND). Methods Databases such as PubMed, EMBASE, WanFang Data, CNKI and CBM were searched comprehensively for studies about SLN for breast cancer from foundation to May 1st, 2018. On the basis of the inclusion and exclusion criteria, extracting data, assessing methodological quality and analyzing results was achieved. RevMan 5.2 was used to carry out statistical analyses. Results A total of six studies, including 3 prospective observational studies and 3 retrospective studies involving 1 730 patients of whom 370 had SLN MIC and 1 360 had negative SLN(-), were qualified for final analysis. The odds ratio(OR) of RRER between group SLN MIC and group SLN(-) of breast cancer patients who didn't performed ALNDwas 1.37(95%CI: 0.72-2.59, I~2=47%, P=0.34), without statistical differences. In addition, there was also no statistical difference in regional recurrence rate between group SLN MIC and group SLN(-) of breast cancer patients without ALND(OR=1.49,95%CI: 0.75～2.97,I~2=40%,P=0.26). Conclusion Compared with patients with negative SLN, SLN MIC does not increase the risk of recurrence in breast cancer patients without ALND.
Objective To systemically evaluate the recurrence related event rate(RRER) of breast cancer with sentinel lymph node micrometastasis(SLN MIC) without axillary lymph node dissection(ALND). Methods Databases such as PubMed, EMBASE, WanFang Data, CNKI and CBM were searched comprehensively for studies about SLN for breast cancer from foundation to May 1st, 2018. On the basis of the inclusion and exclusion criteria, extracting data, assessing methodological quality and analyzing results was achieved. RevMan 5.2 was used to carry out statistical analyses. Results A total of six studies, including 3 prospective observational studies and 3 retrospective studies involving 1 730 patients of whom 370 had SLN MIC and 1 360 had negative SLN(-), were qualified for final analysis. The odds ratio(OR) of RRER between group SLN MIC and group SLN(-) of breast cancer patients who didn't performed ALNDwas 1.37(95%CI: 0.72-2.59, I~2=47%, P=0.34), without statistical differences. In addition, there was also no statistical difference in regional recurrence rate between group SLN MIC and group SLN(-) of breast cancer patients without ALND(OR=1.49,95%CI: 0.75～2.97,I~2=40%,P=0.26). Conclusion Compared with patients with negative SLN, SLN MIC does not increase the risk of recurrence in breast cancer patients without ALND.
引文
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[2]Langer I, Guller U, Viehl CT, et al. Axillary lymph node dissection for sentinel lymph node micrometastases may be safely omitted in early-stage breast cancer patients:long-term outcomes of a prospective study[J]. Indian J Surg Oncol, 2010, 1(1):59-67.
[3]Pepels MJ, de Boer M, Bult P, et al. Regional recurrence in breast cancer patients with sentinel node micrometastases and isolated tumor cells[J]. Ann Surg, 2012, 255(1):116-121.
[4]Guenther J, Hansen NM, Difronzo LA, et al. Axillary dissection is not required for all patients with breast cancer and positive sentinel nodes[J]. Arch Surg, 2003, 138(1):52-56.
[5]Gloyeske NC, Goreal W, O'neil M, et al. Outcomes of breast cancer patients with micrometastases and isolated tumor cells in sentinel lymph nodes[J]. In Vivo, 2011, 25(6):997-1001.
[6]Tvedskov T, Jensen M-B, Ejlertsen B, et al. Prognostic significance of axillary dissection in breast cancer patients with micrometastases or isolated tumor cells in sentinel nodes:a nationwide study[J].Breast Cancer Res Treat, 2015, 153(3):599-606.
[7]Cyr A, Gillanders WE, Aft RL, et al. Micrometastatic disease and isolated tumor cells as a predictor for additional breast cancer axillary metastatic burden[J]. Ann Surg Oncol, 2010, 17(3):303-311.
[8]Edge SB, Compton CC. The American Joint Committee on Cancer:the 7th Edition of the AJCC Cancer Staging Manual and the Future of TNM[J]. Ann Surg Oncol, 2010, 17(6):1471-1474.
[9]中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2017年版)[J].中国癌症杂志, 2017, 27(9):695-759.
[10] Hansen NM, Grube B, Ye X, et al. Impact of micrometastases in the sentinel node of patients with invasive breast cancer[J]. J Clin Oncol, 2009, 27(28):4679-4684.
[11] Imoto S, Ochiai A, Okumura C, et al. Impact of isolated tumor cells in sentinel lymph nodes detected by immunohistochemical staining[J]. Eur J Surg Oncol, 2006, 32(10):1175-1179.
[12] Pugliese MS, Beatty JD, Tickman RJ, et al. Impact and outcomes of routine microstaging of sentinel lymph nodes in breast cancer:significance of the pN0(i+)and pN1mi categories[J]. Ann Surg Oncol, 2009, 16(1):113-120.
[13] Cox C, Kiluk J, Riker A, et al. Significance of sentinel lymph node micrometastases in human breast cancer[J]. J Am Coll Surg, 2008,206(2):261-268.
[14] de Boer M, van Deurzen CH, van Dijck JA, et al. Micrometastases or isolated tumor cells and the outcome of breast cancer[J]. N Engl J Med, 2009, 361(7):653-663.
[15] Huang TW, Kuo KN, Chen KH, et al. Recommendation for axillary lymph node dissection in women with early breast cancer and sentinel node metastasis:A systematic review and meta-analysis of randomized controlled trials using the GRADE system[J]. Int J Surg, 2016, 34:73-80.
[16] Galimberti V, Cole BF, Zurrida S, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases(IBCSG 23-01):a phase 3 randomised controlled trial[J]. Lancet Oncol, 2013, 14(4):297-305.
[2]Langer I, Guller U, Viehl CT, et al. Axillary lymph node dissection for sentinel lymph node micrometastases may be safely omitted in early-stage breast cancer patients:long-term outcomes of a prospective study[J]. Indian J Surg Oncol, 2010, 1(1):59-67.
[3]Pepels MJ, de Boer M, Bult P, et al. Regional recurrence in breast cancer patients with sentinel node micrometastases and isolated tumor cells[J]. Ann Surg, 2012, 255(1):116-121.
[4]Guenther J, Hansen NM, Difronzo LA, et al. Axillary dissection is not required for all patients with breast cancer and positive sentinel nodes[J]. Arch Surg, 2003, 138(1):52-56.
[5]Gloyeske NC, Goreal W, O'neil M, et al. Outcomes of breast cancer patients with micrometastases and isolated tumor cells in sentinel lymph nodes[J]. In Vivo, 2011, 25(6):997-1001.
[6]Tvedskov T, Jensen M-B, Ejlertsen B, et al. Prognostic significance of axillary dissection in breast cancer patients with micrometastases or isolated tumor cells in sentinel nodes:a nationwide study[J].Breast Cancer Res Treat, 2015, 153(3):599-606.
[7]Cyr A, Gillanders WE, Aft RL, et al. Micrometastatic disease and isolated tumor cells as a predictor for additional breast cancer axillary metastatic burden[J]. Ann Surg Oncol, 2010, 17(3):303-311.
[8]Edge SB, Compton CC. The American Joint Committee on Cancer:the 7th Edition of the AJCC Cancer Staging Manual and the Future of TNM[J]. Ann Surg Oncol, 2010, 17(6):1471-1474.
[9]中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2017年版)[J].中国癌症杂志, 2017, 27(9):695-759.
[10] Hansen NM, Grube B, Ye X, et al. Impact of micrometastases in the sentinel node of patients with invasive breast cancer[J]. J Clin Oncol, 2009, 27(28):4679-4684.
[11] Imoto S, Ochiai A, Okumura C, et al. Impact of isolated tumor cells in sentinel lymph nodes detected by immunohistochemical staining[J]. Eur J Surg Oncol, 2006, 32(10):1175-1179.
[12] Pugliese MS, Beatty JD, Tickman RJ, et al. Impact and outcomes of routine microstaging of sentinel lymph nodes in breast cancer:significance of the pN0(i+)and pN1mi categories[J]. Ann Surg Oncol, 2009, 16(1):113-120.
[13] Cox C, Kiluk J, Riker A, et al. Significance of sentinel lymph node micrometastases in human breast cancer[J]. J Am Coll Surg, 2008,206(2):261-268.
[14] de Boer M, van Deurzen CH, van Dijck JA, et al. Micrometastases or isolated tumor cells and the outcome of breast cancer[J]. N Engl J Med, 2009, 361(7):653-663.
[15] Huang TW, Kuo KN, Chen KH, et al. Recommendation for axillary lymph node dissection in women with early breast cancer and sentinel node metastasis:A systematic review and meta-analysis of randomized controlled trials using the GRADE system[J]. Int J Surg, 2016, 34:73-80.
[16] Galimberti V, Cole BF, Zurrida S, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases(IBCSG 23-01):a phase 3 randomised controlled trial[J]. Lancet Oncol, 2013, 14(4):297-305.