腋窝淋巴结清扫术治疗前哨淋巴结活检阴性乳腺癌的系统评价

摘要

Objective To systematically evaluate the effectiveness and safety of axillary lymph node dissection for breast cancer patients with negative sentinel node biopsy.Methods Literatures in CNKI,PubMed,EMBASE and CBMwere searched from their establishment to December 1,2013.Accord-ing to the inclusion and exclusion criteria,trials of axillary lymph node dissection and sentinel node biopsy for breast cancer were strictly screened and extracted for quality assessment and result analysis.Meta-anal-ysis was conducted by using Revman 5.1 software.Results A total of 10 studies involving 7731 patients were eligible for the final analysis.Because of the large differences in research type,measurement indica-tor,follow-up period and statistical index,subgroup analysis was adopted.Meta-analysis was applied for homogeneous researches and the remaining studies were analyzed with qualitative descriptive analysis.The results showed no significant differences in disease-free survival,overall survival,local recurrence rate,and distant metastasis rate in different follow-up periods.Conclusion For breast cancer patients with single invasive lesion,axillary lymph node dissection is not necessary.More high-quality random control trials and long-term follow-up are required to confirm the conclusions of this systematic review.%目的：系统评价腋窝淋巴结清扫术治疗前哨淋巴结活检阴性乳腺癌的有效性和安全性。方法检索 CNKI、PubMed、EMBASE、CBM从建库至2013年12月1日的文献资料，选择腋窝淋巴结清扫术和前哨淋巴结活检术治疗乳腺癌患者的试验，严格按照制订纳入和排除标准对纳入的研究进行筛选、资料提取、质量评价和结果分析。使用 Revman 5．1软件，进行统计学分析（Me-ta-分析）。结果最终纳入10篇文献，患者共7731例。因纳入文献在研究类型、测量指标、随访时间以及统计学指标的差异较大，采用亚组分析，Meta 分析同质研究，其余采用定性的描述性分析。本研究结果显示，在无病生存率、总体生存率、局部复发率、远处转移率方面，不同随访时间腋窝淋巴结清扫术与前哨淋巴结切除术间差异均无统计学意义。结论对于单发浸润性乳腺癌患者前哨淋巴结活检呈阴性时，可不必行腋窝淋巴结清扫术。目前尚需相关高质量随机对照试验和长期的随访进一步证实此系统评价的结论。