乳腺癌保乳术后放射治疗的系统评价

Breast-Conserving Surgery plus Radiotherapy for Breast Cancer:A Systematic Review

目的评价早期乳腺癌保乳术后放射治疗的疗效。方法计算机检索中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库、数字化期刊全文数据库、PubMed、Cochrane Library、SCI及EMBASE数据库,并行手工检索。纳入比较早期乳腺癌保乳术后放疗与根治术的随机对照试验,根据Cochrane系统评价手册4.2.6质量评价标准进行评价,使用RevMan4.2软件进行Meta分析。结果纳入4个研究(1985例)。Meta分析显示,与根治术相比,保乳术后放疗的10年局部复发率差异有统计学意义(比值比1.58,95%可信区间1.01～2.46),而10年总生存率(比值比1.02,95%可信区间0.84～1.24)及远处转移率(比值比1.02,95%可信区间0.84～1.25)差异无统计学意义。结论与根治术相比,乳腺癌保乳术后放疗虽然10年局部复发率较高,但二者远期疗效相同,由于保乳术保留了乳房,达到了美容效果,提高了患者的生活质量,可作为早期乳腺癌的标准治疗方式。

Objective To assess the long-term effect of breast conservation with lumpectomy plus radiation therapy （BCT） for early-stage breast cancer. Methods We searched the randomized controlled trial in PubMed（1966-2008.9）, Cochrane Library （issue3,2008）, EMBASE （1974-2008.9）, SCI （1974-2008.9）, Chinese Biomedicial Database （ 1978- 2008.9）, Chinese Scientific Journals Full-text Database （1989-2008.9）, China Journal Full-text Database （1978- 2008.9）.Quality assessment and data extraction were done by two reviewers independently according to the Coehrane Reviewer＇s handbook4.2.6. Meta-analyses were performed on the results of homogenous studies by RevMan4.2.10. Results We included four studies （1 985 patients）. There was no difference between two groups in overall survival （OR=1.02,95%CI 0.84-1.24） and in distant metastasis at 10 years（OR=1.02,95%CI 0.84-1.25）. But the locoregional recurrence rate at 10 years was significantly higher for the patients assigned to BCT （0R=1.58,95%CI 1.01-2.46,P= 0.04）. Conclusions The locoregional recurrence rate at 10 years was higher for the patients assigned to BCT than the patients assigned to masteetomy. But results for overall survival at 10 years are equivalent to those with mastectomy and improve the quality of life. The distant effectiveness of breast-conservation plus radiation therapy for early-stage breast cancer is now an accepted treatment.