摘要
目的系统评价全乳腺照射(WBI)与加速部分乳腺照射(APBI)治疗早期乳腺癌术后患者的效果和安全性,为早期乳腺癌保乳手术术后放疗措施提供循证参考。方法计算机检索PubMed、The Cochrane Library、CNKI、维普和万方数据库中的相关文献,依据纳入和排除标准筛选关于WBI与APBI治疗早期乳腺癌保乳手术术后效果和安全性的随机对照实验,并进行资料提取,采用Cochrane Reviewers’Handbook 5.1.0进行质量评价,RevMan 5.4统计软件进行Meta分析。结果共纳入9项研究,合计11238例患者。Meta分析结果显示,术后接受WBI与APBI治疗的早期乳腺癌患者的总生存率和淋巴结转移率比较,差异均无统计学意义(P﹥0.05);与术后接受WBI治疗的早期乳腺癌患者相比,术后接受APBI患者的特异性生存率更高、远处转移率更低、急性皮肤毒性更低、不良美容评分更低,但差异均无统计学意义(P﹥0.05)。术后接受APBI治疗的早期乳腺癌患者的复发率明显高于WBI,差异有统计学意义(OR=0.74,95%CI:0.62~0.89,P=0.001)。术后接受WBI治疗的早期乳腺癌患者的迟发性皮肤毒性发生率明显低于APBI,差异有统计学意义(OR=0.76,95%CI:0.67~0.87,P﹤0.01)。结论APBI与WBI对早期乳腺癌保乳手术术后疗效相当,因纳入研究的治疗方法差异和样本量的限制,该结论有待更多高质量的大样本、双盲、随机对照试验加以验证。
Objective To systematically evaluate the efficacy and safety of whole breast irradiation(WBI)compared with accelerated partial breast irradiation(APBI)in the treatment of early breast cancer,so as to provide evidence-based reference for the clinical treatment of breast conserving surgery for early breast cancer.Method PubMed,The Cochrane Library,CNKI,VIP,and Wanfang database were searched by computer to collect the relevant literature on the efficacy and safety of WBI compared with APBI for early breast cancer.After data extraction of the clinical studies that met the inclusion criteria,the quality was evaluated by Cochrane Reviewers’Handbook 5.1.0,and Meta-analysis was performed by Revman 5.4 statistical software.Result Nine studies involving 11238 patients were included.Meta-analysis showed that there was no significant difference in the overall survival rate and lymph node metastasis rate between the two groups(P>0.05).Compared with early breast cancer patients who received WBI treatment after operation,patients who received APBI after operation had higher specific survival rate,lower distant metastasis rate,lower acute skin toxicity and lower adverse cosmetic score,but the differences were not statistically significant(P>0.05).The recurrence rate of early breast cancer patients receiving APBI after operation was significantly higher than that of WBI(OR=0.74,95%CI:0.62-0.89,P=0.001).The incidence of delayed skin toxicity in early breast cancer patients treated with WBI was significantly lower than that of APBI(OR=0.76,95%CI:0.67-0.87,P<0.01).Conclusion Compared with WBI,APBI is a little more effective and safe in the treatment of early breast cancer.Limited by the methodology and sample size of the included literature,this conclusion needs to be verified by high-quality large sample double-blind randomized controlled trials.
作者
丁学锋
李红生
毛宏亮
温鹏军
谢洪霞
魏旭升
DING Xuefeng;LI Hongsheng;MAO Hongliang;WEN Pengjun;XIE Hongxia;WEI Xusheng(Department of Oncology,People’s Hospital of Jiuquan City,Jiuquan 735000,Gansu,China)
出处
《癌症进展》
2021年第7期693-698,共6页
Oncology Progress
关键词
乳腺癌
全乳放疗
加速部分乳腺放疗
META分析
breast cancer
whole breast radiotherapy
accelerated partial breast radiotherapy
Meta-analysis
作者简介
通信作者:魏旭升,邮箱:dxf0756@163.com。
