乳腺癌患者腋窝淋巴结清扫术中胸肌间淋巴结处理必要性的系统评价

Necessity of interpectoral lymph node dissection during axillary lymph node dissection in breast cancer patients:a systematic review

目的探讨不同临床病理特征乳腺癌患者胸肌间淋巴结(IPN)转移率的差异,为腋窝淋巴结清扫术中IPN的处理策略提供参考。方法以interpectoral nodes、interpectoral lymph nodes、Rotter’s nodes、胸肌间淋巴结、Rotter淋巴结等为关键词,检索PubMed、EMBASE、The Cochrane Library、中国知网、万方数据知识服务平台、维普中文期刊服务平台等数据库获得相关文献,由2名研究人员独立对文献进行筛选、审核和提取数据,采集IPN的检出率、转移率及相关临床病理特征。采用RevMan 5.3软件对IPN的检出率、转移率进行meta分析,并分析各项研究中乳腺癌临床分期和腋窝淋巴结是否转移与IPN转移率间的关系。结果共纳入符合标准的研究21项,共计8418例患者。有19项研究(8119例患者)分析了IPN检出率、20项研究(8178例患者)分析了IPN转移率,meta分析选用随机效应模型,合并分析结果显示IPN总体检出率为36%(95%CI 28%~44%,P<0.01)、总体转移率为8%(95%CI 6%~9%,P<0.01)。共有11项研究分析了患者乳腺癌临床分期与IPN转移率间的关系,其中6项研究中乳腺癌Ⅲ期患者IPN转移率高于Ⅰ、Ⅱ期患者,差异均有统计学意义(P均<0.05);共有15项研究分析了患者腋窝淋巴结是否转移与IPN转移率间的关系,其中12项研究腋窝淋巴结转移组IPN转移率高于腋窝淋巴结未转移组,差异均有统计学意义(P均<0.05)。结论大多数接受腋窝淋巴结清扫术的乳腺癌患者术中可不清扫IPN,但临床分期为Ⅲ期、腋窝淋巴结转移的患者则建议在腋窝淋巴结清扫的同时行IPN清扫术。

Objective To investigate the rates of interpectoral lymph node(IPN)metastasis in breast cancer patients with different clinicopathological characteristics,and to provide reference for the management strategy of IPN during axillary lymph node dissection.Methods Keywords,such as“interpectoral nodes,interpectoral lymph nodes,Rotter’s nodes”(in English or in Chinese),were searched in the PubMed,EMBASE,The Cochrane Library,CNKI,Wanfang data,VIP,etc.Two researchers independently screened,reviewed and extracted the data,and collected the detection rate,metastasis rate and relevant clinicopathological characteristics of IPN.RevMan 5.3 software was used to conduct a metaanalysis on the detection rate and metastasis rate of IPN,analyzing the relationship among clinical stage of breast cancer,axillary lymph node metastasis and IPN metastasis rate.Results A total of 21 studies with 8418 patients were included.Random-effect model was used in the meta-analysis,and the combined analysis results showed that the detection rate of IPN was 36%(95%CI 28%-44%,P<0.01)among the 19 studies with 8119 patients,and the overall metastasis rate was 8%(95%CI 6%-9%,P<0.01)among the 20 studies with 8178 patients.A total of 11 studies analyzed the relationship between the clinical stage of breast cancer and the IPN metastasis rate,and the IPN metastasis rate in patients with stageⅢwas significantly higher than those in patients with stageⅠorⅡin 6 of these studies(all P<0.05).A total of 15 studies analyzed the relationship between the axillary lymph node metastasis and the IPN metastasis rate,and the IPN metastasis rate was significantly higher in the axillary lymph node metastasis group than that in the non-metastasis group in 12 of these studies(all P<0.05).Conclusion IPN dissection is not necessary for most breast cancer patients undergoing ALND,but for stageⅢpatients with axillary lymph node metastasis,IPN dissection is recommended during axillary lymph node dissection.