Impact of Axillary Lymph Node Dissection on Breast Cancer Outcome in Clinically Node Negative Patients
Impact of Axillary Lymph Node Dissection on Breast Cancer Outcome in Clinically Node Negative Patients
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DOI：
10.1002/cncr.24174
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发表时间：
2009-04-15
期刊：
影响因子：
6.2
通讯作者：
Cady, Blake
中科院分区：
文献类型：
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作者：
Sanghani, Mona;Balk, Ethan M.;Cady, Blake
背景：乳腺癌腋窝清扫的区域淋巴结控制和生存影响已成为多项随机试验的主题，并得出了不同的结果。本研究回顾并对早期乳腺癌患者腋窝淋巴结清扫的当代试验进行了荟萃分析。方法：系统性 MEDLINE 综述确定了 2000 年 1 月至 2007 年 1 月期间发表的 3 项随机试验，这些试验针对临床淋巴结阴性的早期乳腺癌患者进行腋窝淋巴结清扫与不进行腋窝淋巴结清扫。还确定了第四项腋窝放疗与无腋窝治疗的试验，并将其纳入本次综述中，对生存、腋窝复发、转移性疾病和同侧乳房复发进行荟萃分析。结果：所有试验均报告，在未进行腋窝淋巴结清扫或放疗的情况下，腋窝复发率较高（1.5%-3%，中位随访时间 5-15 年）。在这 4 项试验中，有 3 项试验中的 3 项无论是否接受明确的腋窝治疗，总生存率相似，第四项试验的观察组中非乳腺癌相关死亡率有所增加。荟萃分析发现，与腋窝治疗相关的总生存率（比值比 [OR] 1.55；95% 置信区间 [0]，0.74-3.24）、转移（OR 0.91；95% Cl，0.65-1.29）或同侧乳房复发（OR 1.11；95% Cl，0.68-1.83）没有显着差异。淋巴结切除术后腋窝复发率显着降低（OR 0.28；95% Cl. 0.11-0.73，P
BACKGROUND: The regional lymph node control and survival impact of axillary dissection in breast cancer has been the subject of multiple randomized trials, with various results. This study reviews and conducts a meta-analysis of contemporary trials of axillary dissection in patients with early stage breast cancer. METHODS: A systematic MEDLINE review identified 3 randomized trials published between January 2000 and January 2007 of axillary dissection versus no dissection in clinically lymph node negative early stage breast cancer patients. A fourth trial of axillary radiotherapy versus no axillary treatment was also identified and included in this review, Meta-analyses were performed for survival, axillary recurrence, metastatic disease, and ipsilateral breast recurrence. RESULTS: All trials reported a higher rate of axillary recurrence (1.5%-3%, median follow-up 5-15 years) in the absence of axillary dissection or radiotherapy. Overall survival was similar with and without definitive axillary treatment in 3 of the 4 trials, with an increased rate of non-breast cancer-related death in the observation arm of the fourth trial. Meta-analyses found no significant difference in overall survival (odds ratio [OR] 1.55; 95% confidence interval [0], 0.74-3.24), metastases (OR 0.91; 95% Cl, 0.65-1.29), or ipsilateral breast recurrence (OR 1.11; 95% Cl, 0.68-1.83) associated with axillary treatment. A significantly lower rate of axillary recurrence was seen after lymphadenectomy (OR 0.28; 95% Cl. 0.11-0.73, P