中国女性乳腺癌相关淋巴水肿危险因素的Meta分析

Risk Factors for Breast Cancer-related Lymphedema in Chinese Women:a Meta-analysis

背景乳腺癌相关淋巴水肿(BCRL)是乳腺癌术后最主要的并发症,目前临床尚无有效的治疗手段。因此,及早识别其发生的危险因素具有重要意义,但现有研究结论尚存争议,且国内尚无相关系统评价。目的系统评价中国女性BCRL的危险因素。方法计算机检索CINAHL、PubMed、EMBase、Web of Science、The Cochrane Library、中国知网、维普网、万方数据知识服务平台和中国生物医学文献数据库发表的相关文献,检索时间均从建库至2020年6月。由两名研究者独立筛选文献、提取资料〔第一作者、发表时间、研究类型、样本量、水肿测量方式、水肿程度、随访时间、BCRL相关影响因素(年龄、体质指数、高血压情况、淋巴结转移阳性情况、腋窝淋巴结清扫范围、行腋窝淋巴结清扫术、淋巴结清扫数目、术后愈合并发症情况、化疗情况、放疗情况)〕、对文献进行偏倚风险质量评价,采用RevMan 5.3软件进行Meta分析。结果共纳入31篇文献,BCRL患者共2618例,文献质量整体在中等及以上。Meta分析结果显示,年龄〔OR=2.59,95%CI(1.95,3.45),P<0.00001〕、体质指数〔OR=2.33,95%CI(1.91,2.85),P<0.00001〕、高血压情况〔OR=4.76,95%CI(2.53,8.94),P<0.00001〕、淋巴结转移阳性情况〔OR=1.22,95%CI(1.06,1.39),P=0.005〕、腋窝淋巴结清扫范围〔OR=2.30,95%CI(1.88,2.81),P<0.00001〕、腋窝淋巴结清扫术〔OR=8.29,95%CI(2.32,29.60),P=0.001〕、淋巴结清扫数目≥15个〔OR=1.12,95%CI(1.06,1.19),P<0.0001〕、术后愈合并发症情况〔OR=4.11,95%CI(3.26,5.17),P<0.00001〕、化疗情况〔OR=3.17,95%CI(2.16,4.63),P<0.00001〕、放疗情况〔OR=2.69,95%CI(2.32,3.13),P<0.00001〕是BCRL的影响因素。结论年龄>40岁、体质指数≥24 kg/m2、高血压、淋巴结转移阳性、腋窝淋巴结清扫范围增加、行腋窝淋巴结清扫术、淋巴结清扫数目≥15个、术后愈合并发症、化疗、放疗是BCRL的危险因素。受纳入研究质量和数量的局限性,上述结论尚需开展更多大样本的前瞻性队列研究来进行验证。

Background Breast cancer-related lymphedema(BCRL)is the most common postoperative complication of breast cancer,which cannot be cured clinically at present.Early identification of the risk factors for BCRL may improve the outcome significantly,yet it is still controversial in existing relevant studies,and there is no relevant systematic review in China.Objective To systematically evaluate the risk factors for BCRL in Chinese women.Methods We searched the databases of CINAHL,PubMed,EMBase,Web of Science,The Cochrane Library,CNKI,CQVIP,Wanfang Data and SinoMed for articles about the risk factors of BCRL among Chinese women published from inception to June 2020.Two researchers independently screened the studies based on the inclusion and exclusion criteria,extracted data〔including the first author,time of publication,type of studies,sample size,measurement methods for edema,degree of edema,follow-up time,and BCRL-related factors(age,BMI,hypertension prevalence,lymph node metastasis prevalence,scope of axillary lymph node dissection,having a lymph node dissection,number of lymph nodes dissected,postoperative healing complication,chemotherapy,radiation therapy)〕,and performed risk of bias assessment using the Newcastle-Ottawa Scale.Meta-analysis was performed using RevMan 5.3.Results 31 studies involving 2618 subjects were included,with moderate or high methodological quality.Meta-analysis showed that older age〔OR=2.59,95%CI(1.95,3.45),P<0.00001〕,increased BMI〔OR=2.33,95%CI(1.91,2.85),P<0.00001〕,hypertension〔OR=4.76,95%CI(2.53,8.94),P<0.00001〕,lymph node metastasis〔OR=1.22,95%CI(1.06,1.39),P=0.005〕,extended axillary lymph node dissection〔OR=2.30,95%CI(1.88,2.81),P<0.00001〕,having a lymph node dissection〔OR=8.29,95%CI(2.32,29.60),P=0.001〕,number of dissected lymph nodes≥15〔OR=1.12,95%CI(1.06,1.19),P<0.0001〕,postoperative healing complication〔OR=4.11,95%CI(3.26,5.17),P<0.00001〕,chemotherapy〔OR=3.17,95%CI(2.16,4.63),P<0.00001〕,radiation therapy〔OR=2.69,95%CI(2.32,3.13),P<0.00001〕were risk factors of BCRL.Conclusion BCRL among Chinese women may be associated with various risk factors,such as age>40,BMI≥24 kg/m2,hypertension,lymph node metastasis,extended axillary lymph node dissection,having a lymph node dissection,number of dissected axillary lymph nodes≥15,postoperative healing complication,chemotherapy,and radiation therapy.Due to limited quality and quantity of the included studies,more large-sample prospective cohort studies are required to verify the above conclusion.