Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients - A metaanalysis
Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients - A metaanalysis
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DOI：
10.1002/cncr.11803
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发表时间：
2003-12-01
期刊：
影响因子：
6.2
通讯作者：
Newman, LA
中科院分区：
文献类型：
--
作者：
Degnim, AC;Griffith, KA;Newman, LA
背景在前哨淋巴结（SN）阳性的乳腺癌患者中，完全腋窝淋巴结清扫的价值受到质疑。多份已发表的报告试图确定与阳性非前哨淋巴结（NSN）可能性增加相关的原发性肿瘤和SN的临床病理学特征。由于每项研究中淋巴结评估技术的差异和有限的患者数量，作者进行了荟萃分析，以评估各种特征与NSN转移风险之间的规律性和相对强度。MEDLINE检索确定了15项候选研究，其中11项符合分析标准。对研究的一般要素、评价的病理学特征和选定特征的结果进行了比较。从每项研究中提取原始数据并用于计算比值比。计算Mantel-Haenszel共同比值比以确定相关性的相对强度。尽管方法学上存在差异，但在研究中发现阳性NSN和某些病理特征之间的相关性非常相似。发现与NSN转移可能性最高的5个个体特征是SN转移> 2 mm、SN中的结节性延伸、肿瘤大小> 2 cm、> 1个阳性SN和原发肿瘤中的淋巴管浸润。在SN阳性的乳腺癌患者中，关于病理特征与NSN转移之间的相关性的研究之间存在总体一致性。汇总分析确定了应在SN标本中进行常规评价并纳入前瞻性数据库以开发预测模型的具有最强关联性的因素。(C)2003年美国癌症协会。
BACKGROUND. in breast carcinoma patients with a positive sentinel lymph node (SN), the value of complete axillary lymph node dissection has been questioned. Multiple published reports have attempted to identify clinicopathologic characteristics of the primary tumor and SN that are associated with an increased likelihood of positive nonsentinel lymph nodes (NSN). Because of differences in lymph node evaluation techniques and limited patient numbers in each study, the authors performed a meta-analysis to assess the regularity and relative strength of association between various characteristics and the risk of NSN metastasis.METHODS. A MEDLINE search identified 15 candidate studies, I I of which met the criteria for analysis. General elements of the studies, the pathologic characteristics evaluated, and the results for selected characteristics were compared. Original data were abstracted from each study and used to calculate odds ratios. The Mantel-Haenszel common odds ratios were calculated to determine the relative strength of the associations.RESULTS. Despite methodologic differences, the correlation between positive NSNs and certain pathologic characteristics was found to be remarkably similar among studies. The 5 individual characteristics found to be associated with the highest likelihood of NSN metastasis are SN metastasis > 2 mm in size, extranodal extension in the SN, tumor size > 2 cm, > 1 positive SN, and lymphovascular invasion in the primary tumor.CONCLUSIONS. There is general concordance among studies regarding the association between pathologic characteristics and NSN metastasis in breast carcinoma patients with a positive SN. The pooled analysis identified those factors with the strongest associations that should be evaluated routinely in SN specimens and included in prospective databases for the development of a predictive model. (C) 2003 American Cancer Society.