摘要
目的：采用系统评价的方法比较早期老年乳腺癌的两种手术治疗方法：非腋窝清扫的单纯乳房切除/肿块切除手术和伴腋窝淋巴结清扫的根治／改良根治术,评估其老年乳腺癌治疗中的安全性和有效性。方法：通过计算机检索Cochrane Library(2010年4期)、Pubmed(1985～2011.02).Embase(1985～2011.02).CBM(1985～2011.02)VIP(1985-2011.02)和CNKI(1985～2011.02),等有关行腋窝淋巴结清扫的乳腺癌根治及改良根治术及非腋窝淋巴结清扫的肿块切除、乳房切除等治疗老年乳腺癌的临床对照研究资料,辅以手工检索相关文献及其参考文献目录。由两名评价员对纳入的文献进行资料提取和质量评价,质量评价采RevMan 5.0软件进行统计学分析。结果：共纳入文献5篇,均为英文随机或半随机对照试验,共1635例患者,在五年及十年总生存,无病生率,远处转移,均未见明显差别。但在腋窝复发方面,5年随访时腋窝淋巴结清扫组明显优于非腋窝清扫组(5%vs9%)[OR=0.54,95%CI(0.36,0.80)；P=0.002]但在10年随访时,这种差别不再有统计学意义[OR=1.81,95%CI(0.49,6.61)P=0.37]。在25年随访时,总生存也未见明显差别。结论：对老年能耐受手术治疗的早期乳腺癌患者,避免腋窝淋巴结清扫的手术治疗与腋窝淋巴结清扫手术相比,可以获得同样的生存预期,不失为一种好的选择。目前比较两种手术方式治疗老年乳腺癌的研究尚缺乏,有必要开展和设计更多高质量的随机对照试验。
Objective:To review the efficacy that no axillary lymph node excision surgery compared with axillary lymph node excision surgery for ealry staging elderly patients with breast cancer.Methods:The electronic bibliographic databases, including PubMed,Embase, Cochrane Central Register of Controlled Trials, CBM, CNKI and VIP were searched to assemble the randomized controlled trials (RCTs), and reference lists of relevant to axillary lymph node excision for elder women with breast cancer and reviewed for additional trials. Their data were extracted and evaluated by two reviewers independently with a designed extraction form. the statistic analysis was conducted by using RevMan 5.0 software. Results:Five studies were enrolled which included three randomized controlled trials (RCT) and two quasi-RCT, and involved totally 1635 patients.No significant differences were found between axillary excision surgery and no axillary excision in terms of survival rate,mortality, local relapse rate and distant metastasis rate at 5 years and 10years.when five years, While axillary excision group was with significantly lower local relapse rate,however (5%vs9%[OR=0.54,95%CI (0.36,0.80); P=0.002],at ten years,this diffents disappear.when 25 years,there is also no difference between two groups.Conclusion: When elderly patients with clinical negative breast cancer at early staged,they are able to tolerate surgery, both axillary excision surgery and no axillary excision, no axillary excision have the same expectation of the life,should be a superior option. Since the comparison study on axillary excision surgery and no axillary excision is limited currently, it is necessary to develop and design more high quality randomized controlled trials
引文
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