前哨淋巴结活检与乳腺癌复发风险的系统评价及Meta分析

Sentinel lymph node biopsy and risk of breast cancer recurrence:A systematic review and meta analysis

目的系统评价在不同前哨淋巴结转移状态的乳腺癌中行前哨淋巴结活检(sentinel lymph node biopsy,SLNB)治疗的复发风险。方法检索Pub Med、EMBASE、Wan Fang Data、CNKI、CBM建库至2014年7月1日的文献资料,严格按照纳入和排除标准筛选相关研究,对纳入的研究进行资料提取、质量评价和结果分析。使用Rev Man 5.1.2软件,进行Meta分析。结果最终纳入13篇研究,共14 325例患者,其中8篇RCTs,5篇前瞻性队列研究。因纳入研究在研究类型、测量指标以及随访时间的差异较大,根据随访时间及淋巴结转移状态进行亚组分析。在术后3年、5年的局部复发率及远处转移率方面SLNB组与腋窝淋巴结清扫术(axillary lymph node dissection,ALND)组比较差异均无统计学意义(P>0.05)。Meta分析及长期随访RCTs均支持对于SLN-患者可避免行ALND;对于SLN孤立肿瘤细胞、微转移及SLN-患者,入组缺少长期随访RCTs。结论前哨淋巴结阴性患者仅行SLNB是安全有效的,可避免常规行ALND;对于前哨淋巴结孤立肿瘤细胞、微转移以及阳性的患者应考虑高危因素,慎行SLNB。

Objective To systemically evaluate the recurrence risk of breast cancer with sentinel lymph node biopsy（ SLNB）. Methods Databases CNKI,Pub Med,EMBASE,CBM and Wan Fang Data were searched for studies about sentinel lymph node biopsy for breast cancer from inception to July 1st,2014. According to the inclusion and exclusion criteria,we extracted data,assessed methodological quality and analyzed results. Meta-analysis was conducted using Revman 5. 1. 2 software. Results A total of 13 studies,including 8 RCTs and 5 prospective cohort studies involving 14 325 patients,were eligible for final analysis. Because of the differences in research types,measurement indicators and follow-up time,subgroup analysis was adopted according to follow-up time and SLN metastatic status. There was no significant difference in 3-,5-year local recurrence rate and distant metastasis rate between patients undergoing SLNB and those undergoing axillary lymph node dissection（ ALND）. In SLN-subgroup,meta-analysis and long-term follow-up RCTs supported that ALND can be avoided. Long-term follow-up RCTs were not found in SLN ITC,MIC and SLN ＋ subgroups.Conclusion SLNB is safe and effective for patients with negative SLN and ALND can be avoided. However for those with isolated tumor cells in SLN,micrometastasis or positive SLN,the risk of SLNB should be considered.