{"title":"新辅助系统治疗后肿瘤整形保乳手术的肿瘤学和美容效果：系统回顾和荟萃分析。","authors":"Goran A Ahmed, Daniel H Baron, Amit Agrawal","doi":"10.1007/s10549-024-07566-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Oncoplastic breast-conserving surgery (OBCS) prevents compromise of breast aesthetics following large breast cancer excisions. This systematic review was conducted to investigate the outcomes (oncologic, surgical, cosmetic) of OBCS versus standard breast-conserving surgery (SBCS) and mastectomy post-neo-adjuvant systemic therapy.</p><p><strong>Methods: </strong>Ovid, Web of Science, Cochrane, ClinicalTrials.gov databases were searched up to 24/08/2024. English language peer-reviewed RCTs or observational/cohort studies with ≥ 18-year-old women treated for breast cancer with neoadjuvant chemotherapy (NACT) and/or hormonal therapy comparing OBCS to SBCS and/or mastectomy were included. Of 6794 articles, 32 underwent full-text assessment and eleven met the inclusion criteria. The review was conducted using PRISMA guidelines. Two reviewers independently extracted data and assessed risk of bias (Newcastle-Ottowa Scale). Meta-analysis using a random-effects model were performed where data allowed.</p><p><strong>Results: </strong>Eleven cohort studies (n = 4594) included OBCS (n = 912), SBCS (n = 1122) and mastectomy (n = 2560) after NACT. Post-NACT tumour size was 20(9-44) mm, 13(0-23)mm [SMD 0.62, 95%CI(-0.24,1.48), p = 0.16] and 20(10-31)mm [SMD 0.05, 95%CI(-0.53,0.63), p = 0.86] in the OBCS, SBCS and mastectomy groups respectively. The margin re-excision rate was significantly lower in OBCS than in SBCS [2.9%(0-11.1%) vs. 6.1%(0-18.5%); OR 0.35, 95%CI(0.15,0.80), p = 0.01]. All other oncologic outcomes, including positive margin rate, and overall survival, were not statistically different between the groups. Cosmetic outcomes and patient-reported outcome measures were marginally in favour of OBCS [OBCS 50-66% vs SBCS 37.6-55% very satisfied].</p><p><strong>Conclusion: </strong>OBCS after NACT appears oncologically safe and a potential alternative in patients with partial or poor tumour response to NACT. Further studies are required, directly comparing well-matched OBCS with SBCS and mastectomy patients after NACT.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":""},"PeriodicalIF":3.0000,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Oncologic and cosmetic outcomes of oncoplastic breast-conserving surgery after neoadjuvant systemic therapy: systematic review and meta-analysis.\",\"authors\":\"Goran A Ahmed, Daniel H Baron, Amit Agrawal\",\"doi\":\"10.1007/s10549-024-07566-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Oncoplastic breast-conserving surgery (OBCS) prevents compromise of breast aesthetics following large breast cancer excisions. This systematic review was conducted to investigate the outcomes (oncologic, surgical, cosmetic) of OBCS versus standard breast-conserving surgery (SBCS) and mastectomy post-neo-adjuvant systemic therapy.</p><p><strong>Methods: </strong>Ovid, Web of Science, Cochrane, ClinicalTrials.gov databases were searched up to 24/08/2024. English language peer-reviewed RCTs or observational/cohort studies with ≥ 18-year-old women treated for breast cancer with neoadjuvant chemotherapy (NACT) and/or hormonal therapy comparing OBCS to SBCS and/or mastectomy were included. Of 6794 articles, 32 underwent full-text assessment and eleven met the inclusion criteria. The review was conducted using PRISMA guidelines. Two reviewers independently extracted data and assessed risk of bias (Newcastle-Ottowa Scale). Meta-analysis using a random-effects model were performed where data allowed.</p><p><strong>Results: </strong>Eleven cohort studies (n = 4594) included OBCS (n = 912), SBCS (n = 1122) and mastectomy (n = 2560) after NACT. Post-NACT tumour size was 20(9-44) mm, 13(0-23)mm [SMD 0.62, 95%CI(-0.24,1.48), p = 0.16] and 20(10-31)mm [SMD 0.05, 95%CI(-0.53,0.63), p = 0.86] in the OBCS, SBCS and mastectomy groups respectively. The margin re-excision rate was significantly lower in OBCS than in SBCS [2.9%(0-11.1%) vs. 6.1%(0-18.5%); OR 0.35, 95%CI(0.15,0.80), p = 0.01]. All other oncologic outcomes, including positive margin rate, and overall survival, were not statistically different between the groups. Cosmetic outcomes and patient-reported outcome measures were marginally in favour of OBCS [OBCS 50-66% vs SBCS 37.6-55% very satisfied].</p><p><strong>Conclusion: </strong>OBCS after NACT appears oncologically safe and a potential alternative in patients with partial or poor tumour response to NACT. Further studies are required, directly comparing well-matched OBCS with SBCS and mastectomy patients after NACT.</p>\",\"PeriodicalId\":9133,\"journal\":{\"name\":\"Breast Cancer Research and Treatment\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2024-12-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Breast Cancer Research and Treatment\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10549-024-07566-6\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Breast Cancer Research and Treatment","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10549-024-07566-6","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
Oncologic and cosmetic outcomes of oncoplastic breast-conserving surgery after neoadjuvant systemic therapy: systematic review and meta-analysis.
Purpose: Oncoplastic breast-conserving surgery (OBCS) prevents compromise of breast aesthetics following large breast cancer excisions. This systematic review was conducted to investigate the outcomes (oncologic, surgical, cosmetic) of OBCS versus standard breast-conserving surgery (SBCS) and mastectomy post-neo-adjuvant systemic therapy.
Methods: Ovid, Web of Science, Cochrane, ClinicalTrials.gov databases were searched up to 24/08/2024. English language peer-reviewed RCTs or observational/cohort studies with ≥ 18-year-old women treated for breast cancer with neoadjuvant chemotherapy (NACT) and/or hormonal therapy comparing OBCS to SBCS and/or mastectomy were included. Of 6794 articles, 32 underwent full-text assessment and eleven met the inclusion criteria. The review was conducted using PRISMA guidelines. Two reviewers independently extracted data and assessed risk of bias (Newcastle-Ottowa Scale). Meta-analysis using a random-effects model were performed where data allowed.
Results: Eleven cohort studies (n = 4594) included OBCS (n = 912), SBCS (n = 1122) and mastectomy (n = 2560) after NACT. Post-NACT tumour size was 20(9-44) mm, 13(0-23)mm [SMD 0.62, 95%CI(-0.24,1.48), p = 0.16] and 20(10-31)mm [SMD 0.05, 95%CI(-0.53,0.63), p = 0.86] in the OBCS, SBCS and mastectomy groups respectively. The margin re-excision rate was significantly lower in OBCS than in SBCS [2.9%(0-11.1%) vs. 6.1%(0-18.5%); OR 0.35, 95%CI(0.15,0.80), p = 0.01]. All other oncologic outcomes, including positive margin rate, and overall survival, were not statistically different between the groups. Cosmetic outcomes and patient-reported outcome measures were marginally in favour of OBCS [OBCS 50-66% vs SBCS 37.6-55% very satisfied].
Conclusion: OBCS after NACT appears oncologically safe and a potential alternative in patients with partial or poor tumour response to NACT. Further studies are required, directly comparing well-matched OBCS with SBCS and mastectomy patients after NACT.
期刊介绍：
Breast Cancer Research and Treatment provides the surgeon, radiotherapist, medical oncologist, endocrinologist, epidemiologist, immunologist or cell biologist investigating problems in breast cancer a single forum for communication. The journal creates a "market place" for breast cancer topics which cuts across all the usual lines of disciplines, providing a site for presenting pertinent investigations, and for discussing critical questions relevant to the entire field. It seeks to develop a new focus and new perspectives for all those concerned with breast cancer.
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