Effect of Adjuvant Radiation after Breast Conserving Surgery on the Risk of Recurrence for Patients with Ductal Carcinoma In Situ of the Breast: A Meta Analysis Based on Randomized Controlled Trials
-
摘要:
目的 用Meta分析方法评价放射治疗能否降低乳腺导管原位癌(DCIS)保乳术后的复发率。 方法 计算机检索PubMed、EMBASE、CochraneLibrarlv、中国生物医学文献数据库、中文科技期刊全文数据库、中国期刊全文数据库、万方数据库, 手工检索搜集有关放疗辅助治疗DCIS的随机对照试验, 用RevMan5.0软件进行统计分析。 结果 纳入4篇随机对照试验共计2701例乳腺癌患者, Meta分析结果显示, 保乳术后联合放射治疗与单纯手术比较, 乳腺导管原位癌复发率较低, 两者相比差异有统计学意义(RR=0.45, 95%CI: 037~0.55)亚组分析均提示辅助放疗可以降低其复发率。 结论 DCIS患者保乳术后放射治疗可以降低其复发率, 高危患者可能受益更多。 Abstract:Objective This study aims to determine whether adjuvant radiotherapy could reduce the recurrence of ductal carcinoma in situ(DCIS). Methods PubMed, Embase, Cochrane Library, Chinese biomedical literature database, Chinese Scientific Journal full-text database, Chinese Journal full-text database, WANGFANG, and the bibliographies of retrieved articles for randomized controlled trials were searched to compare the risk of recurrence in patients treated with and without radiotherapy.The data were analyzed using Review Manager 5.0. Results Four randomized controlled trials in 2, 701 participants were included in this study.The results of the meta analysis showed that radiotherapy following breast conserving surgery significantly affected the risk of recurrence in DCIS treatment compared with surgery alone.All the analyzed subgroups benefited from the application of radiotherapy. Conclusion Adjuvant radiotherapy can reduce the risk of recurrence in DCIS treatment, from which participants with high risk may benefit more than those with low risk. -
Key words:
- Radiotherapy /
- Ductal carcinoma in situ /
- Breast conserving surgery /
- Meta analysis
-
图 1 放疗联合手术与单纯手术治疗DCIS复发率Meta分析
Figure 1. Radiotherapy combined with operation and simple operation for treatment of the recurrence rate of DCIS meta analysis
图 2 放疗联合手术与单纯手术治疗DCIS复发率的亚组分析（病灶大小）
Figure 2. Subgroup analysis of recurrence rate of DCIS for those treated with radiotherapy combined with surgery and those treated with simple surgery (tumor size)
图 3 放疗联合手术与单纯手术治疗DCIS复发率的亚组分析（年龄）
Figure 3. Subgroup analysis of recurrence rate of DCIS for those treated with radiotherapy combined with surgery and those treated with simple surgery (age)
表 1 纳入研究的基本情况
Table 1. Basic information of the studies included
表 2 纳入研究的方法学质量评价
Table 2. Quality assessment about methods for the studies included
-
[1] Harris JR, Lippman ME, Veronesi U, et al. Breast cancer(2)[J]. N Engl J Med, 1992, 327(6): 390-398. doi: 10.1056/NEJM199208063270606 [2] Burstein HJ, Polyak K, WongJS, et al. Ductal carcinoma in situ of the breast[J]. N Engl J Med, 2004, 350(14): 1430-1441. doi: 10.1056/NEJMra031301 [3] Levine M. Clinical practice guidelines for the care and treatment of breast cancer: adjuvant systemic therapy for node-negative breast cancer(summary of the 2001 update)[J]. CMAJ, 2001, 164(2): 213. http://pubmedcentralcanada.ca/pmcc/articles/PMC80684/ [4] Solin LJ, Fourquet A, Vicini FA, et al. Salvage treatment for local recurrence after breast—conserving surgery and radiation as initial treatment for mammographically detected ductal carcinoma in situ of the breast[J]. Cancer, 2001, 91(6): 1090-1097. doi: 10.1002/1097-0142(20010315)91:6<1090::AID-CNCR1104>3.0.CO;2-D [5] The management of ductal carcinoma in situ(DCIS). The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Canadian Association of Radiation Oncologists[J]. CMAJ, 1998, 158 Suppl 3: S27-34. http://www.ncbi.nlm.nih.gov/pubmed/9484275 [6] Houghton J, George WD, CuzickJ, et al. Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New Zealand: randomised controlled trial[J]. Lancet, 2003, 362(9378): 95-102. doi: 10.1016/S0140-6736(03)13859-7 [7] Cuzick J, Sestak I, Pinder SE, et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long—term results from the UK/ANZ DCIS trial[J]. Lancet Oncol, 2011, 12(1): 21-29. doi: 10.1016/S1470-2045(10)70266-7 [8] Fisher B, Dignam J, Wolmark N, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B—17[J]. J Clin Oncol, 1998, 16(2): 441-452. doi: 10.1200/JCO.1998.16.2.441 [9] Bijker N, Meijnen P, Peterse JL, et al. Breast—conserving treatment with or without radiotherapy in ductal carcinoma—in—situ: ten—year results of European Organisation for Research and Treatment of Cancer randomized phaseⅢtrial 10853-a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group[J]. J Clin Oncol, 2006, 24(21): 3381-3387. doi: 10.1200/JCO.2006.06.1366 [10] Emdin SO, Granstrand B, Ringberg A, et al. SweDCIS: Radiothera- py after sector resection for ductal carcinoma in situ of the breast. Results of a randomised trial in a population offered mammography screening[J]. Acta Oncol, 2006, 45(5): 536-543. doi: 10.1080/02841860600681569 [11] 齐晓伟摘编. 乳腺导管原位癌患者仅行局部切除而不加放射治疗的疗效观察: 美国东部肿瘤协作组的临床试验结果[J/CD]. 中华乳腺病杂志: 电子版, 2011, 5(2): 258-260. [12] Hughes LL, Wang M, Page DL, et al. Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group[J]. J Clin Oncol, 2009, 27 (32): 5319-5324. doi: 10.1200/JCO.2009.21.8560 [13] Silverstein MJ. The University of Southern California/Van Nuys prognostic index for ductal carcinoma in situ of the breast[J]. Am J Surg, Oct 2003, 186(4): 337-343. [14] Viani GA, Stefano EJ, Afonso SL, et al. Breast-conserving surgery with or without radiotherapy in women with ductal carcinoma in situ: a meta-analysis of randomized trials[J]. Radiat Oncol, 2007, 2 (1): 28. [15] Tavassoli FA, Devilee P. World Health Organization classificat ion of tumours Pathology and genetics of tumours of the breast and female genital organs[M]. Lyon: IARC Press, 2003: 60-73. -
下载:
点击查看大图
计量
- 文章访问数: 38
- HTML全文浏览量: 5
- PDF下载量: 2
- 被引次数: 0
