早期乳腺癌保乳与全乳房切除术后远期疗效meta分析

Long-term efficacy of breast-conserving surgery versus total mastectomy surgery in early stage breast cancer: a meta-analysis

目的 系统评价早期乳腺癌保乳术(breast conserving surgery,BCS)与全乳房切除术(total mastectomy,TM)的远期疗效。方法系统检索2014年1月至2017年7月Medline(Ovid SP)、PubMed、Embase、Science Citation Index、中国知网、万方及中国生物医学文献数据库,按照纳入及排除标准筛选符合标准的文献。使用Review Manager 5.2进行meta分析。结果共纳入11篇文献,均为高质量回顾性病例对照研究,共16 330例患者,其中BCS组8538例,TM组7792例。Meta分析结果显示,BCS组术后10年生存率明显高于TM组(OR=0.38,95%CI 0.15～0.95,P=0.04),但两组术后局部复发率(OR=0.82,95%CI 0.42～1.60,P=0.56)、术后远处转移率(OR=0.80,95%CI 0.47～1.38,P=0.43)、术后3年生存率(OR=0.70,95%CI 0.31～1.55,P=0.38)及术后5年生存率(OR=0.50,95%CI0.21～1.19,P=0.12)等差异无显著性(P>0.05)。结论BCS的远期疗效与TM相当,且具有更高的10年生存率,手术创伤小,值得临床应用。

Objective To systematically assess the long-term efficacy of breast-conserving surgery（BCS） and total mastectomy（TM）foi early breast cancer. Method Clinical controlled studies that BCS and TM for early breast cancer were identified. The studies data were extracted and statistical analyzed using Review Manager 5.2（Rev Man; Cochrane Collaboration, Copenhagen, Denmark）. Result A total of 11 studies involving 16330 patients were finally included, with 8538 cases in BCS group and 7792 cases in TM group. Results of Metaanalysis showed that in BCS group compared with TM group, the postoperative 10-year survival rates（OR=0.38, 95% CI 0.15-0.95.P=0.04） was better, but no significant difference was noted in terms of postoperative local recurrence rates（OR=0.82, 95% CI 0.42-1.60.P=0.56）, postoperative distant metastasis rates（OR=0.80, 95% CI 0.47-1.38, P=0.43）, postoperative 3-year survival rates（OR=0.70, 95%CI 0.31-1.55, P=0.38） and postoperative 5-year survival rates（OR=0.50, 95% CI0.21-1.19, P=0.12）（all P〈0.05）. Conclusion BCS car provide broadly similar long-term efficacy as TM. Besides, it has a better 10-year survival rates. The surgical trauma of BCS is small and worthy of clinical application.