关节干预乳腺癌:一个系统的审查
Roshni Rao1, David Euhus, Helen G Mayo
1Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9155, USA. roshni.rao@utsouthwestern.edu
JAMA
|October 3, 2013
概括
轴节点剖析对没有可触摸节点的乳腺保护疗法接受的乳腺癌患者提供了很少的益处,并增加了伤害. 单独的哨兵节点活检通常足以进行分期和治疗决策.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 乳腺癌研究研究 乳腺癌研究
背景情况:
- 根据最近的临床试验数据,正在对乳腺癌的传统手术进行重新评估.
- 了解关干预的作用对于优化患者的治疗结果至关重要.
研究的目的:
- 审查乳腺癌治疗中股干预 (手术和非手术) 的证据.
- 评估这些干预措施对复发,死亡率和发病率的影响.
主要方法:
- 在多个数据库 (Ovid MEDLINE,Cochrane) 中进行了系统的文献搜索.
- 包括的研究包括临床试验,观察性研究和至少2年后续的元分析.
- 审查了1070篇出版物,其中17篇符合最终纳入标准.
主要成果:
- 对于没有可触摸的关节的乳房保护疗法,完整的关节剖析在单独的哨兵节点活检上显示出极少的益处.
- 完整的关节剖析没有提供生存优势,并且与哨兵结节活检相比,增加了淋巴 edem (14%) 的风险.
- 哨兵节点活检对于分期和指导辅助治疗决策是有效的.
结论:
- 在接受乳腺保护疗法的精选乳腺癌患者中,关节解剖与益处相比危害更大.
- 干预措施应根据个体患者的个人资料进行调整,以平衡疾病控制和尽量减少发病率.
- 对于可触摸或经过活检证明的转移,乳房切除时的阳性哨兵节点,或在乳房保护疗法中超过3个阳性哨兵节点,表示进行完整的关节解剖.
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