前哨淋巴结阳性乳腺癌患者不行腋窝淋巴结清扫预后的Meta分析

A Meta-analysis of the prognosis of sentinel node-positive breast cancer patients forgoing axillary lymph node dissection

目的评价不行腋窝淋巴结清扫对前哨淋巴结阳性乳腺癌患者预后的影响。方法系统检索Medline、Embase、Cochrane图书馆中的相关文献，所有检索截至2014年4月。由2位评价员独立筛选并提取数据资料，对符合纳入标准的研究使用RevMan5软件进行统计学分析。结果共检索到1026篇文献摘要，通过筛选最终纳入18个临床对照研究，病例总数为47894例，其中前哨淋巴结微转移组7389例，宏转移组35217例，前哨淋巴结阳性未区分宏转移与微转移组5288例。结果显示，微转移患者，仅行前哨淋巴结活检组与行腋窝淋巴结清扫组相比，5年腋窝复发率、5年无瘤生存率和5年总体生存率差异无统计学意义，OR值分别为1．78（95％C1：0．72～4．39，P=0．21），0．76（95％CI：0．56～1．04，P=0．08），0．77（95％CI：0．43—1．40，P=0．39）；宏转移患者，仅行前哨淋巴结活检组与行腋窝淋巴结清扫组相比，5年腋窝复发率差异无统计学意义，OR值为1．21（95％CI：0．76～1．91，P=0．42）；前哨淋巴结阳性未区分宏转移与微转移患者，仅行前哨淋巴结活检组与行腋窝淋巴结清扫组相比，5年腋窝复发率和5年整体生存率差异无统计学意义，OR值分别为1．29（95％CI：0．92～1．80，P=0．14），0．96（95％CI：0．64～1．45，P=0．84）。结论前哨淋巴结阳性不行腋窝淋巴结清扫术较行腋窝淋巴结清扫术对乳腺癌患者的远期生存无明显影响。

Objective To compare the prognosis of sentinel node-positive breast cancer patients forgoing axillary lymph node dissection. Methods A systematic literature search（ Medline, Embase, Cochrane Library）ended in April 2014 was performed to identify all eligible articles. Two reviewers independently screened and extracted data. RevMan5 was used for statistical analysis. Results A total of 1026 abstracts were retrieved and 18 clinical con- trolled studies finally included, the total number of patients were 47 894, 7389 had micrometastases in sentinel lymph node, 35 217 had macrometastases in sentinel lymph node and 5288 had positive sentinel lymph node regard- less of micrometastases or macrometastases. For patients with MIC, the 5- year axillary recurrence rate , 5- year dis- ease free survival and 5-year overall survival had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection, （ OR = 1.78; 95% CI： 0.72-4.39, P=0.21）,（OR=0.76, 95%CI： 0.56-1.04, P=0. 08）,（OR=0.77, 95%CI： 0.43-1.40, P= 0.39）. For patients with MAC, the 5- year axillary recurrence rate had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection, （ OR = 1.21 ; 95% CI： O. 76-1.91, P =0.42）. For patients with positive sentinel lymph node regardless of micrometastases or macrometastases, the 5-year axillary recurrence rate and 5-year overall survival had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection, （ OR = 1.29 ; 95% CI： 0. 92-1.80, P = 0. 14） , （ OR = 0. 96, 95% CI： 0. 64-1.45, P = 0.84）. Conclusions Among patients with limited positive SLN of breast cancer, patients forgoing ALND compared with ALND did not have obvious affect on long-term survival.