早期浸潤性乳腺癌保乳與全乳腺切除手術遠期療效評價： Meta分析結果_《中國普外基礎與臨床雜志》

作者：

曹鋒 , 李非

首都醫科大學宣武醫院普通外科（北京 100053）;

關鍵詞：

乳腺癌保乳手術全乳腺切除 Meta分析

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目的系統評價早期浸潤性乳腺癌保乳（breast-conserving therapy，BCT）與全乳腺切除手術（mastectomy therapy，MT）的遠期療效。方法采用Cochrane系統評價方法, 檢索Cochrane圖書館臨床對照試驗數據庫、PubMed、EMBASE、Cancer Lit等數據庫，2名評價員獨立提取信息并評價文獻質量后交叉比對，評價指標包括隨訪結束時死亡人數、局部復發率及總復發率，采用RevMan 4.2.2軟件進行Meta分析。結果共有6篇文獻進入Meta分析，累積樣本含量3 933例。BCT組與MT組隨訪結束時死亡人數差異無統計學意義（OR=1.05，95% CI： 0.93～1.19，P=0.45），而BCT組局部復發率（OR=1.64，95% CI： 1.10～2.44，P=0.01）及總復發率（OR=1.42，95% CI： 1.22～1.64，P lt;0.01）明顯高于MT組。結論對于早期浸潤性乳腺癌，行BCT與MT患者長期預后相當，但BCT患者術后局部復發率明顯升高，需引起注意。

引用本文： 曹鋒,李非. 早期浸潤性乳腺癌保乳與全乳腺切除手術遠期療效評價： Meta分析結果. 中國普外基礎與臨床雜志, 2010, 17(6): 601-605. doi: 復制

1.	Halsted WS. Ⅰ. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1889, to January, 1894 [J]. Ann Surg, 1894; 20(5): 497-555.
2.	Fisher B. Breast cancer [J]. Postgrad Med, 1969; 45(4): 73-78.
3.	Veronesi U, Banfi A, Saccozzi R, et al. Conservative treatment of breast cancer. A trial in progress at the Cancer Institute of Milan [J]. Cancer, 1977; 39(6 Suppl): 2822-2826.
4.	Fisher B, Wolmark N, Fisher ER, et al. Lumpectomy and axillary dissection for breast cancer: surgical, pathological, and radiation considerations [J]. World J Surg, 1985; 9(5): 692-698.
5.	Keynes G. The radium treatment of carcinoma of the breast [J]. Br J Surg, 1932, 19(75): 415-480.
6.	鐘穎, 孫強, 徐雅莉, 等. 30年乳腺癌治療趨勢的變化 [J]. 中國普外基礎與臨床雜志, 2009; 16(11): 911-917.
7.	袁家賓, 林洋, 劉洪, 等. 早期乳腺癌保乳手術的療效分析 [J]. 中國普外基礎與臨床雜志, 2008; 15(7): 477-478.
8.	Consensus Development Panel. NIH Consensus Development Conference on the Treatment of Early-Stage Breast Cancer. Bethesda, Maryland, June 18-21, 1990 [J]. J Natl Cancer Inst Monogr, 1992; (11): 1-187.
9.	王深明, 姚陳. 乳腺癌保乳手術的若干問題探討 [J]. 中華外科雜志, 2009; 47(7): 494-496.
10.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? [J] . Control Clin Trials, 1996; 17(1): 1-12.
11.	Blichert-Toft M, Nielsen M, Düring M, et al. Long-term results of breast conserving surgery vs. mastectomy for early stage invasive breast cancer: 20-year follow-up of the Danish randomized DBCG-82TM protocol [J]. Acta Oncol, 2008; 47(4): 672-681.
12.	Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial [J]. Cancer, 2003; 98(4): 697-702.
13.	Lichter AS, Lippman ME, Danforth DN Jr, et al. Mastectomy versus breast-conserving therapy in the treatment of stage Ⅰ and Ⅱ carcinoma of the breast: a randomized trial at the National Cancer Institute [J]. J Clin Oncol, 1992; 10(6): 976-983.
14.	Straus K, Lichter A, Lippman M, et al. Results of the National Cancer Institute early breast cancer trial [J]. J Natl Cancer Inst Monogr, 1992; (11): 27-32.
15.	Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer [J]. N Engl J Med, 2002; 347(16): 1227-1232.
16.	Veronesi U, Saccozzi R, Del Vecchio M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast [J]. N Engl J Med, 1981; 305(1): 6-11.
17.	Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer [J]. N Engl J Med, 1989; 320(13): 822-828.
18.	Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer [J]. N Engl J Med, 2002; 347(16): 1233-1241.
19.	van Dongen JA, Bartelink H, Fentiman IS, et al. Factors influencing local relapse and survival and results of salvage treatment after breast-conserving therapy in operable breast cancer: EORTC trial 10801, breast conservation compared with mastectomy in TNM stageⅠ and Ⅱbreast cancer [J]. Eur J Cancer, 1992; 28A(4-5): 801-805.
20.	van Dongen JA, Bartelink H, Fentiman IS, et al. Randomized clinical trial to assess the value of breast-conserving therapy in stage Ⅰ and Ⅱ breast cancer, EORTC 10801 trial [J]. J Natl Cancer Inst Monogr, 1992; (11): 15-18.
21.	van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial [J]. J Natl Cancer Inst, 2000; 92(14): 1143-1150.
22.	Arriagada R, Lê MG, Rochard F, et al. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group [J]. J Clin Oncol, 1996; 14(5): 1558-1564.
23.	Jatoi I, Proschan MA. Randomized trials of breast-conserving therapy versus mastectomy for primary breast cancer: a pooled analysis of updated results [J]. Am J Clin Oncol, 2005; 28(3): 289-294.
24.	Johansen J, Overgaard J, Rose C, et al. On behalf of DBCG. Cosmetic outcome and breast morbidity in breast-conserving treatment-results from the Danish DBCG-82TM national randomized trial in breast cancer [J]. Acta Oncol, 2002; 41(4): 369-380.
25.	張保寧. 乳腺癌保乳手術的研究進展 [J]. 中國普外基礎與臨床雜志, 2005; 12(3): 204-206.
26.	楊春明. 乳腺癌治療的現代概念 [J]. 中國普外基礎與臨床雜志, 2008; 15(7): 467-470.

1. Halsted WS. Ⅰ. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1889, to January, 1894 [J]. Ann Surg, 1894; 20(5): 497-555.
2. Fisher B. Breast cancer [J]. Postgrad Med, 1969; 45(4): 73-78.
3. Veronesi U, Banfi A, Saccozzi R, et al. Conservative treatment of breast cancer. A trial in progress at the Cancer Institute of Milan [J]. Cancer, 1977; 39(6 Suppl): 2822-2826.
4. Fisher B, Wolmark N, Fisher ER, et al. Lumpectomy and axillary dissection for breast cancer: surgical, pathological, and radiation considerations [J]. World J Surg, 1985; 9(5): 692-698.
5. Keynes G. The radium treatment of carcinoma of the breast [J]. Br J Surg, 1932, 19(75): 415-480.
6. 鐘穎, 孫強, 徐雅莉, 等. 30年乳腺癌治療趨勢的變化 [J]. 中國普外基礎與臨床雜志, 2009; 16(11): 911-917.
7. 袁家賓, 林洋, 劉洪, 等. 早期乳腺癌保乳手術的療效分析 [J]. 中國普外基礎與臨床雜志, 2008; 15(7): 477-478.
8. Consensus Development Panel. NIH Consensus Development Conference on the Treatment of Early-Stage Breast Cancer. Bethesda, Maryland, June 18-21, 1990 [J]. J Natl Cancer Inst Monogr, 1992; (11): 1-187.
9. 王深明, 姚陳. 乳腺癌保乳手術的若干問題探討 [J]. 中華外科雜志, 2009; 47(7): 494-496.
10. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? [J] . Control Clin Trials, 1996; 17(1): 1-12.
11. Blichert-Toft M, Nielsen M, Düring M, et al. Long-term results of breast conserving surgery vs. mastectomy for early stage invasive breast cancer: 20-year follow-up of the Danish randomized DBCG-82TM protocol [J]. Acta Oncol, 2008; 47(4): 672-681.
12. Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial [J]. Cancer, 2003; 98(4): 697-702.
13. Lichter AS, Lippman ME, Danforth DN Jr, et al. Mastectomy versus breast-conserving therapy in the treatment of stage Ⅰ and Ⅱ carcinoma of the breast: a randomized trial at the National Cancer Institute [J]. J Clin Oncol, 1992; 10(6): 976-983.
14. Straus K, Lichter A, Lippman M, et al. Results of the National Cancer Institute early breast cancer trial [J]. J Natl Cancer Inst Monogr, 1992; (11): 27-32.
15. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer [J]. N Engl J Med, 2002; 347(16): 1227-1232.
16. Veronesi U, Saccozzi R, Del Vecchio M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast [J]. N Engl J Med, 1981; 305(1): 6-11.
17. Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer [J]. N Engl J Med, 1989; 320(13): 822-828.
18. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer [J]. N Engl J Med, 2002; 347(16): 1233-1241.
19. van Dongen JA, Bartelink H, Fentiman IS, et al. Factors influencing local relapse and survival and results of salvage treatment after breast-conserving therapy in operable breast cancer: EORTC trial 10801, breast conservation compared with mastectomy in TNM stageⅠ and Ⅱbreast cancer [J]. Eur J Cancer, 1992; 28A(4-5): 801-805.
20. van Dongen JA, Bartelink H, Fentiman IS, et al. Randomized clinical trial to assess the value of breast-conserving therapy in stage Ⅰ and Ⅱ breast cancer, EORTC 10801 trial [J]. J Natl Cancer Inst Monogr, 1992; (11): 15-18.
21. van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial [J]. J Natl Cancer Inst, 2000; 92(14): 1143-1150.
22. Arriagada R, Lê MG, Rochard F, et al. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group [J]. J Clin Oncol, 1996; 14(5): 1558-1564.
23. Jatoi I, Proschan MA. Randomized trials of breast-conserving therapy versus mastectomy for primary breast cancer: a pooled analysis of updated results [J]. Am J Clin Oncol, 2005; 28(3): 289-294.
24. Johansen J, Overgaard J, Rose C, et al. On behalf of DBCG. Cosmetic outcome and breast morbidity in breast-conserving treatment-results from the Danish DBCG-82TM national randomized trial in breast cancer [J]. Acta Oncol, 2002; 41(4): 369-380.
25. 張保寧. 乳腺癌保乳手術的研究進展 [J]. 中國普外基礎與臨床雜志, 2005; 12(3): 204-206.
26. 楊春明. 乳腺癌治療的現代概念 [J]. 中國普外基礎與臨床雜志, 2008; 15(7): 467-470.

《中國普外基礎與臨床雜志》

早期浸潤性乳腺癌保乳與全乳腺切除手術遠期療效評價： Meta分析結果

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《中國普外基礎與臨床雜志》

早期浸潤性乳腺癌保乳與全乳腺切除手術遠期療效評價： Meta分析結果

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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