对影响乳腺癌治疗后患者报告的手臂症状的风险因素进行系统回顾和荟萃分析：考虑放疗的影响

IF 5.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Breast Pub Date : 2024-09-17 DOI:10.1016/j.breast.2024.103812

Yuqin Liang , Yuedan Zhou , Ruud Houben , Karolien Verhoeven , Sofia Rivera , Liesbeth J. Boersma

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引用次数: 0

摘要

目的使用 EORTC QLQ-BR23 问卷（BR23）系统回顾乳腺癌（BC）患者报告的手臂症状（AS）的风险因素，并考虑放疗（RT）的影响。方法截至 2024 年 3 月 5 日，使用关键词 "乳腺肿瘤"、"放疗 "和 "BR23 "检索 PubMed、Embase、Cochrane Library、MEDLINE 和 Web of Science。纳入标准：单变量和多变量分析。排除标准：妊娠、复发、BC远处转移、再次放疗或未进行放疗。采用批判性评估技能计划（CASP）清单对纳入论文的偏倚风险进行评估。采用风险比 (RR) 或标准化平均差 (SMD) 及 95% 置信区间 (CI) 作为效应测量指标，进行描述性分析和荟萃分析。结果734项研究中有18项被纳入，样本量从172到2208不等。常见的风险因素包括腋窝淋巴结清扫术（ALND）、乳房切除术、化疗（CT）和 RT（分别有 6、5、4 和 4 项研究）。在荟萃分析中，与前哨淋巴结活检相比，ALND是手臂疼痛（RR [95 % CI] = 1.75 [1.14; 2.71]）、淋巴水肿（RR [95 % CI] = 5.41 [3.48; 8.39]）和总体AS（SMD [95 % CI] = 0.49 [0.14; 0.83]）的风险因素。RT不是风险因素，但与无腋窝RT相比，腋窝RT会显著增加总的AS（SMD [95 % CI] = 0.55 [0.40; 0.70]）。腋窝RT是一个重要的风险因素，而普通RT则不是。

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A systematic review and meta-analysis of risk factors influencing patient-reported arm symptoms post-breast cancer treatment: Accounting for radiotherapy impact

Objectives

To systematically review risk factors for patient-reported arm symptoms (AS) in breast cancer (BC), considering radiotherapy (RT) impact, using the EORTC QLQ-BR23 questionnaire (BR23).

Methods

PubMed, Embase, Cochrane Library, MEDLINE, and Web of Science were searched using the keywords "breast neoplasms", "radiotherapy", and "BR23" up to March 5th, 2024. Inclusion criteria: both univariate and multivariate analyses. Exclusion criteria: pregnancy, recurrence, distant metastasis BC, reirradiation, or lack of RT. The risk of bias of included papers was assessed using the Critical Appraisal Skills Program (CASP) checklist. Descriptive and meta-analyses were conducted using risk ratio (RR) or standardized mean difference (SMD) with 95 % confidence intervals (CI) as effect measures. A random-effects model was applied if I² > 50 %.

Results

Eighteen out of 734 studies were included, with sample sizes ranging from 172 to 2208. Commonly reported risk factors included axillary lymph node dissection (ALND), mastectomy, chemotherapy (CT), and RT (6, 5, 4, and 4 studies, respectively). In meta-analyses, ALND was a risk factor for arm pain (RR [95 % CI] = 1.75 [1.14; 2.71]), lymphedema (RR [95 % CI] = 5.41 [3.48; 8.39]), and overall AS (SMD [95 % CI] = 0.49 [0.14; 0.83]) compared to sentinel lymph node biopsy. RT was not a risk factor, but axillary RT significantly increased overall AS (SMD [95 % CI] = 0.55 [0.40; 0.70]) compared to no axillary RT.

Conclusion

ALND and mastectomy were the primary risk factors for patient-reported AS. Axillary RT was a significant risk factor, whereas general RT was not.

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来源期刊

Breast 医学-妇产科学

CiteScore

8.70

自引率

2.60%

发文量

165

审稿时长

59 days

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.