中华放射医学与防护杂志

张秋宁,吕青芳,刘锐锋,等.乳腺癌根治术后1~3个腋淋巴结阳性的T₁~T₂期患者放射治疗提高生存获益的Meta分析[J].中华放射医学与防护杂志,2015,35(8):598-602.Zhang Qiuning,Lyu Qingfang,Liu Ruifeng,et al.Meta-analysis on survival rate after post-mastectomy radiotherapy for breast cancer patients with T₁-T₂ and 1-3 positive lymph nodes[J].Chin J Radiol Med Prot,2015,35(8):598-602

乳腺癌根治术后1~3个腋淋巴结阳性的T₁~T₂期患者放射治疗提高生存获益的Meta分析

Meta-analysis on survival rate after post-mastectomy radiotherapy for breast cancer patients with T₁-T₂ and 1-3 positive lymph nodes

投稿时间：2015-01-08

DOI：10.3760/cma.j.issn.0254-5098.2015.08.009

中文关键词: 乳腺癌腋淋巴结放疗疗效 Meta分析

英文关键词:Breast cancer Axillary lymph nodes Radiotherapy Efficacy Meta-analysis

基金项目:

作者	单位	E-mail
张秋宁	730097 兰州, 甘肃省肿瘤医院放疗科
吕青芳	兰州大学附属第一临床医学院研究生院
刘锐锋	730097 兰州, 甘肃省肿瘤医院放疗科
田金徽	730097 兰州, 甘肃省肿瘤医院放疗科
杨碎胜	730097 兰州, 甘肃省肿瘤医院放疗科
魏世鸿	730097 兰州, 甘肃省肿瘤医院放疗科
罗宏涛	730097 兰州, 甘肃省肿瘤医院放疗科
白晓蓉	730097 兰州, 甘肃省肿瘤医院放疗科
包蔚郁	730097 兰州, 甘肃省肿瘤医院放疗科
王小虎	730097 兰州, 甘肃省肿瘤医院放疗科	xhwanggansu@163.com

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中文摘要:

目的评价乳腺癌(改良)根治术后1~3个腋淋巴结阳性的T₁~T₂期患者放射治疗的疗效。方法检索国内外相关数据库, 以主题词和自由词相结合查阅相关文献。按照Cochrane系统评价手册5.2质量评价标准,对纳入文献的方法学进行质量评价,用RevMan5.2软件进行Meta分析。结果纳入乳腺癌(改良)根治术后1~3个腋淋巴结阳性的T₁~T₂期患者,共14个研究,4 643例患者。其中,术后放疗组2 080例,术后未放疗组2 563例。与术后未放疗组相比,术后放疗组可以提高总生存率(OR 1.89,95% CI 1.55~2.31, P<0.05)及无病生存率(OR 2.16,95% CI 1.80~2.60,P<0.05), 且降低了局部区域复发率(OR 0.22,95% CI 0.16~0.30, P<0.05)及远处转移率(OR 0.57,95% CI 0.35~0.94,P<0.05)。以年龄及肿瘤的大小进行亚组分析,<40岁和≥40岁的患者局部区域复发率差异有统计学意义(OR 0.15,95%CI 0.05~0.48;OR 0.33,95%CI 0.13~0.80,P<0.05),术后放疗对T₁及T₂患者均有益(OR 0.48,95%CI 0.24~0.96;OR 0.53,95%CI 0.32~0.89,P<0.05)。结论乳腺癌术后1~3个腋淋巴结阳性的T₁~T₂期患者放疗可以提高总的生存率及无病生存率,并且降低局部区域的复发率及远处转移率。

英文摘要:

Objective To comprehensively assess the effectiveness of post-mastectomy radiotherapy (PMRT) on the local control and survival of breast cancer patients with T₁-T₂ and 1-3 positive axillary lymph nodes using Meta-analysis. Methods Searching the documents of the domestic and foreign medical information databases with references to other papers to identify all clinical controlled trials on post-mastectomy radiotherapy versus without irradiation for postoperative breast cancer with T₁-T₂ and 1-3 positive lymph nodes. Quality assessment of these studies' methodology and date extraction were conducted according to the Cochrane Reviewer's handbook 5.2. Meta-analysis was performed using RevMan 5.2 software. Results There were 14 studies and 4 643 patients enrolled, including 2 080 cases in PMRT group and 2 563 in no- PMRT group. The Meta-analysis showed that there was a significant benefit for PMRT on overall survival rate (OR 1.89, 95% CI 1.55-2.31, P<0.05), disease-free survival (OR 2.16, 95% CI 1.80-2.60, P<0.05), while decreasing the risk of locoregional recurrence (OR 0.22, 95% CI 0.16-0.30, P<0.05) and distant metastasis rate (OR 0.57, 95% CI 0.35-0.94,P<0.05). For further subset analysis, there are statistical significance between ages <40 and ≥40 (OR 0.15,95%CI 0.05-0.48;OR 0.33,95%CI 0.13-0.80,P<0.05), stages T₁ and T₂ (OR 0.48,95%CI 0.24-0.96; OR 0.53,95%CI 0.32-0.89,P<0.05) in breast cancer. Conclusions PMRT has benefit for overall survival rate, disease-free survival and significantly reduces the locoregional recurrence rate, distant metastasis rate in patients with T₁-T₂ tumors with 1-3 positive nodes. PMRT should be considered for patients with T₁-T₂ tumors with 1-3 positive nodes.

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