James Lucocq , Hassan Baig , Kenneth Elder , Gordon Urquhart , Ravi Sharma , Laszlo Romics , Beatrix Elsberger
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引用次数: 0
Abstract
Introduction
Recent and historical trials have suggested that the omission of axillary surgery is oncologically safe in node-negative early breast cancer. This meta-analysis investigates the feasibility of the omission of axillary surgery (SLNB or ALND) in terms of oncological outcomes and adjuvant treatment decisions.
Method
A systematic search of Medline, Embase and Cochrane Central was conducted. Random-effect meta-analysis was conducted to compare recurrence and survival outcomes between omission of axillary surgery and SLNB or ALND. Differences in real-world adjuvant treatment decisions and patient reported outcomes were investigated.
Results
Ten studies (omission, n = 3716; SLNB/ALND, n = 4604/785) investigated oncological outcomes (pooled rates, T1 88 %; Grade 1–2 80 %; ER-positive 91.2 %; HER2-positive 4.4 %; ductal carcinoma 74 %). In the omitted group, the pooled rates of local, axillary and distant recurrence (follow-up, 8 years 9 months) were 3.0 % (95 %CI,1.5–5.9 %), 2.5 % (95 %CI,1.3–4.8 %; 5year, 1.0 %) and 3.6 % (95 %CI,2.0–6.5 %; 5year, 2.7 %), respectively. When comparing omission to SLNB/ALND, there were no differences in local recurrence (OR 0.91; 95 %CI,0.56–1.50), distant metastasis (OR 0.91; 95 %CI,0.56–1.50), BCM (OR 1.00; 95 %CI,0.63–1.60), OS (HR 0.88; 95 %CI,0.65–1.19) or DFS (HR 0.91; 95 %CI,0.76–1.11). Axillary recurrence was higher in the omission group compared to SLNB/ALND (OR 4.42; 95 %CI,1.5–12.8) but not in SLNB alone (OR 2.85; 95 %CI,0.1–133.8). Omission of axillary surgery was associated with lower rates of adjuvant chemotherapy, radiotherapy and hormonal treatment but quality of evidence was poor.
Conclusion
Omission of axillary surgery is safe in node-negative early breast cancer. Prospective data is required to investigate the impact of omission on adjuvant treatment decision.
期刊介绍:
The Breast is an international, multidisciplinary journal for researchers and clinicians, which focuses on translational and clinical research for the advancement of breast cancer prevention, diagnosis and treatment of all stages.