对1～3个淋巴结转移乳腺癌患者放疗的系统评价

Systematic review of postmastectomy radiotherapy for breast cancer patients with one to three positive lymph nodes

目的评价术后放疗对伴有1~3个淋巴结转移的乳腺癌根治术患者的局部控制率和远期生存率的影响。方法通过对PubMed数据库、EBM Reviews-Cochrane中心注册的对照试验、Embase数据库、ICTRP平台、中国生物医学文献数据库(CBM)、中国知识资源总库(CNKI)、中文科技期刊数据库(VIP)和中国肿瘤数据库进行检索数据库进行检索,检索日期截止至2015年12月31日,纳入所有关于伴1~3个淋巴结转移的乳腺癌患者的术后放疗的随机对照试验。使用Revman5.3软件进行meta分析。结果共纳入4个随机对照试验,1 254例患者。4个试验质量好。对于随访10~20年的结果进行分析。结果显示:局部复发率的风险比(hazard ratio,HR)值为0.23,95%置信区间(95%CI)为(0.15,0.37),P<0.000 01,存在异质性(P=0.09,I^2=59%)。总生存率的HR值为0.82,95%CI为(0.71,0.93),P=0.002,无异质性(P=0.65,I^2=0%)。无远处转移生存率的HR值为0.71,95%CI为(0.56,0.90),P=0.005,无异质性(P=0.63,I^2=0%)。无病生存率的HR值为0.74,95%CI为(0.66,0.85),P<0.000 01,无异质性(P=0.49,I^2=0%)。结论术后放疗可以降低1~3个淋巴结转移乳腺癌患者的局部复发率,提高远期生存率。

Objective To evaluate the effect of postmastectomy radiotherapy（PMRT）on the rate of loco-regional recurrence and survival for breast cancer patients undergoing radical mastectomy with one to three positive lymph nodes. Methods The database of Pubmed, Embase, EBM Reviews-Cochrane Central Register of Controlled Trials, CBM, CNKI, VIP, and Chinese Cancer were searched. All randomized controlled trials about postmastectomy radiotherapy on breast cancer patients with 1-3 positive lymph nodes were considered for inclusion. Revman 5.3 was used in the meta analysis. Results Four trials enrolled 1 254 breast cancer women with 1-3 positive lymph nodes were included. The studies were high quality according to the evaluations of the quality criteria. After 10 to 20 years follow-up, the results showed that, 460 patients were analyzed in the result of loco-regional recurrence, the hazard ratio （HR） was 0.23, 95%CI （0.15, 0.37）, the result showed statistical difference （P〈0.000 01）, and the heterogeneity was existed （P=0.09,I2=59%）. One thousand two hundred and fifty-four patients were analyzed in the result of overall survival, theHR was 0.82, 95%CI （0.71, 0.93）, the result showed statistical difference （P=0.002 ）, and there did not existed heterogeneity （P=0.65,I2=0%）. Four hundred and sixty patients were analyzed in the result of metastasis-free survival, theHR was 0.71, 95%CI （0.56, 0.90）, the result showed statistical difference （P=0.005）, and there did not existed heterogeneity （P=0.63,I2=0%）. Nine hundred and seventy-seven patients were analyzed in the result of disease free survival, theHR was 0.74, 95%CI （0.66, 0.85）, the result showed statistical difference （P〈0.000 01）, and there did not existed heterogeneity （P=0.49,I2=0%）. Conclusion Through this systematic review, we consider that postmastectomy radiotherapy could reduce the loco-regional recurrence and increase the overall survival for long-term.