Can axillary radiotherapy replace axillary dissection for patients with positive sentinel nodes? A systematic review and meta-analysis.
Can axillary radiotherapy replace axillary dissection for patients with positive sentinel nodes? A systematic review and meta-analysis.
复制标题
DOI：
10.1016/j.cdtm.2017.01.005
复制
发表时间：
2017-03-25
影响因子：
--
通讯作者：
Chen B
中科院分区：
文献类型：
--
作者：
Zhao M;Liu WG;Zhang L;Jin ZN;Li Z;Liu C;Li DB;Ma Y;Zhang JW;Jin F;Chen B
比较腋窝放疗（ART）与完成腋窝淋巴结清扫术（cALND）对前哨淋巴结阳性的临床淋巴结阴性乳腺癌患者的疗效。使用检索词“乳腺癌”、“前哨淋巴结活检”、“腋窝放射治疗”或“区域淋巴结照射”对 2004 年至 2016 年间发表的文章在 PubMed、EMBASE 和 Cochrane 图书馆进行文献检索。荟萃分析中仅纳入前哨淋巴结阳性患者的随机对照试验。确定了两项随机对照试验和三项回顾性研究。报告的总生存率（风险比 [HR] = 1.09，95% 置信区间 [CI]：0.75–1.43，P = 0.365）、无病生存率（HR = 1.01，95% CI：0.58–1.45，P = 0.144）和腋窝复发率（1.2% 和 0.4%，以及两组的比例相似，分别为 1.3% 和 0.8%。 ART 组中缺乏对淋巴结受累程度的了解似乎对辅助全身治疗的实施没有重大影响。对于前哨淋巴结阳性、临床淋巴结阴性乳腺癌患者，ART 并不逊色于 cALND。 SLNB 后使用 cALND 获得的信息可能对辅助全身治疗的实施没有重大影响。
To compare the efficacy of axillary radiotherapy (ART) with that of completion axillary lymph node dissection (cALND) in clinically node-negative breast cancer patients with a positive sentinel lymph node. A literature search was performed in PubMed, EMBASE and Cochrane Library by using the search terms “breast cancer”, “sentinel lymph node biopsy”, “axillary radiotherapy” or “regional node irradiation” for articles published between 2004 and 2016. Only randomized controlled trials that included patients with positive sentinel nodes were included in the meta-analysis. Two randomized controlled trials and three retrospective studies were identified. The reported overall survival rate (hazard ratio [HR] = 1.09, 95% confidence interval [CI]: 0.75–1.43, P = 0.365), disease-free survival rate (HR = 1.01, 95% CI: 0.58–1.45, P = 0.144), and axillary recurrence rate (1.2% and 0.4%, and 1.3% and 0.8%, respectively) were similar in both groups. The absence of knowledge on the extent of nodal involvement in the ART group appeared to have no major impact on the administration of adjuvant systemic therapy. ART is not inferior to cALND in the patients with clinically node-negative breast cancer who had a positive sentinel lymph node. Information obtained by using cALND after SLNB may have no major impact on the administration of adjuvant systemic therapy.