背景:乳腺癌是女性中最常见的癌症。乳腺癌的手术治疗已逐步从根治性乳房切除术过渡到保乳手术。在这个荟萃分析中,我们的目标是比较肿瘤保乳手术(OS)与传统保乳手术(BCS)的疗效和安全性.
方法:我们搜索了Medline,WebofScience,Embase,Cochrane数据库,临床试验.gov,和CNKI至2024年4月30日。包括来自队列研究和随机对照试验(RCTs)的数据。结果包括主要结果(再切除,局部复发,切缘阳性,乳房切除术),次要结果和安全性结果。使用Cochrane偏差风险评估工具和纽卡斯尔-渥太华量表评估结果质量。
结果:我们的研究包括52项研究,包含46,835名患者。主要结果包括再切除,局部复发,切缘阳性,还有乳房切除术,OS优于BCS有显著差异(RR0.68[0.56,0.82],RR0.62[0.47,0.82],RR0.76[0.59,0.98],RR分别为0.66[0.44、0.98]),表明OS的疗效优越。此外,OS表现出显著的美学益处(RR1.17[1.03,1.33]和RR1.34[1.18,1.52])。而OS组的总并发症明显较少(RR0.70[0.53,0.94]),具体并发症的差异不显著.此外,亚组分析是根据国籍进行的,样本量,质量,和类型。
结论:与BCS相比,OS在各个方面表现出优异或至少可比的结果。
BACKGROUND: Breast cancer is the most common cancer among women. The surgical treatment of breast cancer has transitioned progressively from radical mastectomy to breast-conserving surgery. In this meta-analysis, we are aiming to compare oncoplastic breast-conserving surgery (OS) with conventional breast-conserving surgery (BCS) in terms of efficacy and safety.
METHODS: We searched Medline, Web of Science, Embase, Cochrane databases, Clinicaltrial.gov, and CNKI until April 30, 2024. Data from cohort studies and randomized controlled trials (RCTs) were included. Outcomes included primary outcomes (re-excision, local recurrence, positive surgical margin, mastectomy), secondary outcomes and safety outcomes. The Cochrane Risk of Bias Assessment Tool and Newcastle-Ottawa Scale were used to evaluate the quality of outcomes.
RESULTS: Our study included 52 studies containing 46,835 patients. Primary outcomes comprise re-excision, local recurrence, positive surgical margin, and mastectomy, there were significant differences favoring OS over BCS (RR 0.68 [0.56, 0.82], RR 0.62 [0.47, 0.82], RR 0.76 [0.59, 0.98], RR 0.66 [0.44, 0.98] respectively), indicating superior efficacy of OS. Additionally, OS demonstrated significant aesthetic benefits (RR 1.17 [1.03, 1.33] and RR 1.34 [1.18, 1.52]). While total complications were significantly fewer in the OS group (RR 0.70 [0.53, 0.94]), the differences in specific complications were not significant. Furthermore, subgroup analyses were conducted based on nationality, sample size, quality, and type.
CONCLUSIONS: OS demonstrates either superior or at least comparable outcomes across various aspects when compared to BCS.