摘要:
Objective To comprehensively assess the effectiveness of post-mastectomy radiotherapy (PMRT) on the local control and survival of breast cancer patients with T1-T2 and 1-3 positive axillary lymph nodes using Meta-analysis.Methods Searching the documents of the domestic and foreign medical information databases with references to other papers to identify all clinical controlled trials on post-mastectomy radiotherapy versus without irradiation for postoperative breast cancer with T1-T2 and 1-3 positive lymph nodes.Quality assessment of these studies' methodology and date extraction were conducted according to the Cochrane Reviewer's handbook 5.2.Meta-analysis was performed using RevMan 5.2 software.Results There were 14 studies and 4 643 patients enrolled,including 2 080 cases in PMRT group and 2 563 in no-PMRT group.The Meta-analysis showed that there was a significant benefit for PMRT on overall survival rate (OR 1.89,95% CI 1.55-2.31,P < 0.05),disease-free survival (OR 2.16,95% CI 1.80-2.60,P < 0.05),while decreasing the risk of locoregional recurrence (OR 0.22,95% CI0.16-0.30,P <0.05) and distant metastasis rate (OR 0.57,95% CI 0.35-0.94,P <0.05).For further subset analysis,there are statistical significance between ages < 40 and ≥ 40 (OR0.15,95% CI0.05-0.48;OR 0.33,95% CI 0.13-0.80,P < 0.05),stages T1 and T2 (OR 0.48,95% CI 0.24-0.96;OR 0.53,95% CI 0.32-0.89,P <0.05) in breast cancer.Conclusions PMRT has benefit for overall survival rate,disease-free survival and significantly reduces the locoregional recurrence rate,distant metastasis rate in patients with T1-T2 tumors with 1-3 positive nodes.PMRT should be considered for patients with T1-T2 tumors with 1-3 positive nodes.%目的 评价乳腺癌(改良)根治术后1~3个腋淋巴结阳性的T1~T2期患者放射治疗的疗效.方法 检索国内外相关数据库,以主题词和自由词相结合查阅相关文献.按照Cochrane 系统评价手册5.2质量评价标准,对纳入文献的方法学进行质量评价,用RevMan5.2软件进行Meta分析.结果 纳入乳腺癌(改良)根治术后1~3个腋淋巴结阳性的T1 ~ T2期患者,共14个研究,4 643例患者.其中,术后放疗组2 080例,术后未放疗组2 563例.与术后未放疗组相比,术后放疗组可以提高总生存率(OR 1.89,95% CI 1.55 ~2.31,P<0.05)及无病生存率(OR 2.16,95%CI1.80 ~2.60,P<0.05),且降低了局部区域复发率(OR0.22,95% CI0.16 ~0.30,P<0.05)及远处转移率(OR0.57,95% CI0.35 ~0.94,P<0.05).以年龄及肿瘤的大小进行亚组分析,<40岁和≥40岁的患者局部区域复发率差异有统计学意义(OR 0.15,95%CI0.05 ~0.48;OR0.33,95% CI0.13 ~0.80,P<0.05),术后放疗对T1及T2患者均有益(OR 0.48,95%CI 0.24~0.96;OR 0.53,95%CI0.32 ~0.89,P<0.05).结论 乳腺癌术后1~3个腋淋巴结阳性的T1 ~ T2期患者放疗可以提高总的生存率及无病生存率,并且降低局部区域的复发率及远处转移率.