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中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 166 -171. doi: 10.3877/cma.j.issn.1674-3946.2022.02.014

论著

年轻乳腺癌患者保乳术后是否有更高的局部复发率的Meta分析
赵光楠1, 王敏1, 王媛1, 曾圣光1, 严俊1, 郑爱秋1,()   
  1. 1. 518053 广东深圳,香港大学深圳医院乳腺外科
  • 收稿日期:2021-07-19 出版日期:2022-04-26
  • 通信作者: 郑爱秋

Meta-analysis of whether there is a higher local recurrence rate in young breast cancer patients after breast-conserving surgery

Guangnan Zhao1, Min Wang1, Yuan Wang1, Shengguang Zeng1, Jun Yan1, Aiqiu Zheng1,()   

  1. 1. Department of Breast Surgery, Shenzhen Hospital, University of Hong Kong, Shenzhen Guangdong Province 518053, China
  • Received:2021-07-19 Published:2022-04-26
  • Corresponding author: Aiqiu Zheng
  • Supported by:
    Medical Research Foundation of Guangdong Province(B2021116)
引用本文:

赵光楠, 王敏, 王媛, 曾圣光, 严俊, 郑爱秋. 年轻乳腺癌患者保乳术后是否有更高的局部复发率的Meta分析[J]. 中华普外科手术学杂志(电子版), 2022, 16(02): 166-171.

Guangnan Zhao, Min Wang, Yuan Wang, Shengguang Zeng, Jun Yan, Aiqiu Zheng. Meta-analysis of whether there is a higher local recurrence rate in young breast cancer patients after breast-conserving surgery[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(02): 166-171.

目的

研究年轻乳腺癌患者接受保乳手术后是否比非年轻乳腺癌患者有更高的局部复发率。

方法

计算机检索PubMed、EMBASE、中国知网、维普数据库、Google 学术、万方数据库深圳市卫生健康电子文献共享平台等数据库,比较年轻乳腺癌患者(小于35~45岁)与非年轻乳腺癌患者(大于35~45岁)保乳术后局部复发率的临床对照研究。采用STATA 12.0软件对纳入研究进行Meta分析,对汇总后的相对危险系数(RR)及95%可信区间(CI)进行分析,并对纳入文献的发表偏倚进行分析。

结果

共纳入23项研究(共18775例患者)。总体分析,RR=2.639,95%CI:2.338~2.979,说明年轻乳腺癌组较非年轻乳腺癌组有更高的局部复发率,且结论差异有统计学意义;而对接受手术时的所在年份(以该时间段的最晚年份进行分组)进行亚组分析时发现,在2010年至2020年期间接受手术的患者,RR=1.348,95%CI:0.653~2.780,说明该时期的年轻组乳腺癌患者比非年轻组乳腺癌患者有更高的局部复发率,但差异无统计学意义。

结论

在近10年接受保乳手术的年轻乳腺癌患者,其术后局部复发率与非年轻乳腺癌患者相比差异无统计学意义,局部复发情况得到明显控制,治疗效果得到显著改善。故在目前的诊疗规范指导下,年龄较低并不增加乳腺癌患者保乳术后复发的风险,具有保乳指征的年轻乳腺癌患者,同样可以通过保乳手术,得到有效的治疗。

Objective

To investigate whether young breast cancer patients undergoing breast-conserving surgery have a higher rate of local recurrence than non-young breast cancer patients.

Methods

PubMed,Embase,CNKI,VIP database,Google Scholar,Wanfang database,Shenzhen Health Electronic Literature Sharing Platform,and and other databases were searched by computer to compare the l the local recurrence rate after breast-preserving surgery between young breast cancer patients(less than 35~45 years old)and non-young breast cancer patients(more than 35~45 years old). Stata12.0 software was used for Meta-analysis of the included studies,the RR and 95% confidence interval(CI)were analyzed,as well as publication bias of the included literatures.

Results

A total of 23 studies(18,775 patients)were included. Overall analysis,RR=2.639,95%CI:2.338~2.979,indicating that young breast cancer group had a higher local recurrence rate than non-young breast cancer group,and the difference was statistically significant. For patients who underwent surgery from 2010 to 2020,RR=1.348,95%CI:0.653~2.780 indicating that young breast cancer patients in this period had a higher local recurrence rate than non-young breast cancer patients,but the difference was not statistically significant.

Conclusion

In recent 10 years,the local recurrence rate of young breast cancer patients who have received breast-conserving surgery has no statistical significance compared with non-young breast cancer patients,and the local recurrence has been significantly controlled,and the treatment effect has been significantly improved Therefore,under the guidance of current diagnosis and treatment norms,younger age does not increase the risk of recurrence of breast cancer patients after breast-conserving surgery. Young breast cancer patients with breast-conserving surgery can also receive effective treatment through breast-conserving surgery.

表1 23篇接受保乳手术的纳入文献相关信息
序号 作者 国家 年龄划分界限(岁) 接受手术时所处的年份(年) 中位随访时间(年) 肿瘤分期 病理类型 手术切缘 有无放疗 患者总数(例)
1 Anuja Jhingran 美国 40 1980~1997 5 0期 原位癌 部分阳性 150
2 Yoon-Seok Kim 韩国 40 2002~2007 5 1期 浸润癌 阴性 不详 223
3 E. Botteri 意大利 35 2000~2003 6 不详 浸润癌 不详 2784
4 Daniel H 美国 35 1970~1981 5 不详 不详 部分阳性 部分有 456
5 Antonio Toesca 意大利 40 1996~2007 6.66 0期 原位癌 部分阳性 232
6 Nina Bijker 荷兰,法国,意大利,英国 40 1986~1996 10.5 0期 原位癌 部分阳性 部分有 1010
7 Carlos A. Perez 美国 40 1970~1997 6.6 不详 浸润癌 部分阳性 1347
8 Bas Kreike 荷兰 40 1979~1988 5.5 1-2期 浸润癌 部分阳性 1024
9 Voogd A C 荷兰 35 1980~1989 9.8 1-2期 浸润癌 部分阳性 879
10 John Boyages 美国 35 1968~1982 6.6 1-2期 浸润癌 不详 783
11 Carson Leong 澳大利亚 35 1980~1994 6.6 1-2期 浸润癌 部分阳性 452
12 肖琪 中国 40 2011~2014 5.91 1-2期 浸润癌 不详 201
13 C. A. McBain 英国 40 1989~1992 6.4 1-2-3期 浸润癌 部分阳性 2159
14 EMMANUEL TOUBOUL 法国 40 1976~1993 7.29 1期2期 浸润癌 部分阳性 528
15 Andrew C 英国 45 1982~1994 10 不详 各个类型 部分阳性 509
16 R. Arriagada 法国 40 1954~1983 20 不详 浸润癌 不详 717
17 J.J. Jobsen 荷兰 40 1984~1997 5.9 不详 浸润癌 部分阳性 部分有 1085
18 Yuka Ono 日本 40 1993~2010 9.3 不详 各个类型 阴性 419
19 聂斌 中国 40 2010~2012 5 不详 各个类型 阴性 75
20 谢小军 中国 35 2010~2013 5 不详 浸润癌 不详 部分有 55
21 C. Saita 日本 35 2002~2010 8.1 不详 不详 部分阳性 部分有 820
22 周冬冬 中国 35 2000~2010 8.58 不详 浸润癌 不详 不详 765
23 Kim, Hee 韩国 40 2000~2005 5 不详 浸润癌 不详 不详 2102
图2 23项研究18775例乳腺癌患者以肿瘤类型亚组总体局部复发率分析
图4 23项研究18775例年轻乳腺癌患者针对放疗情况亚组总体局部复发率分析
图6 23篇乳腺癌患者文献发表偏倚分析
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