乳腺癌局部区域治疗相关淋巴水肿
2021年6月9日，日本乳腺癌学会《乳腺癌》在线发表中国医学科学院北京协和医学院北京协和医院孙强等学者的研究报告，对两种局部区域治疗（区域淋巴结放疗、腋窝淋巴结清扫）与乳腺癌相关淋巴水肿风险进行了系统回顾和荟萃分析。
该研究对2010年1月1日～2020年1月1日美国国家医学图书馆、爱思唯尔、荷兰易学文摘和英国医学杂志数据库发表的乳腺癌相关淋巴水肿风险因素和发病率或患病率临床研究进行文献检索。两名研究者独立选择文献提取相关数据并计算相应精确二项式95%置信区间。利用随机效应混合模型对提取数据进行汇总。
结果，从93篇文献筛选出19项研究，淋巴水肿发生率为3%～36.7%，汇总发生率为14.29%（95%置信区间：13.79～14.79）。
腋窝淋巴结清扫与未清扫患者相比，淋巴水肿风险高3.67倍（95%置信区间：2.25～5.98），异质性高（I²=81%，P<0.00001）。剔除患者自我报告淋巴水肿发生率过高的研究后，腋窝淋巴结清扫与未清扫相比，淋巴水肿风险高2.99倍（95%置信区间：2.44～3.66），异质性低（I²=0%，P=0.83）。
放疗与未放疗患者相比，淋巴水肿风险高1.82倍（95%置信区间：0.92～3.59）。不过，腋窝锁骨上区域淋巴结放疗与乳房胸壁放疗患者相比，淋巴水肿风险高2.66倍（95%置信区间：0.73～9.70）。
因此，该研究结果表明，区域淋巴结放疗与乳房胸壁放疗相比，淋巴水肿风险显著较高。腋窝淋巴结清扫与腋窝放疗相比，虽然早发乳腺癌相关淋巴水肿风险相似，但是风险趋势较高。
Breast Cancer. 2021 Jun 9. Online ahead of print.
Loco-regional therapy and the risk of breast cancer-related lymphedema: a systematic review and meta-analysis.
Yan Lin, Ying Xu, Changjun Wang, Yu Song, Xin Huang, Xiaohui Zhang, Xi Cao, Qiang Sun.
Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China.
BACKGROUND: This meta-analysis was designed to assess the association between two loco-regional therapies, regional nodal irradiation and axillary lymph node dissection, and breast cancer-related lymphoedema.
METHODS: We searched PubMed, Science Direct, Embase, and BMJ databases for clinical studies published between January 1, 2010 and January 1, 2020, which assessed risk factors and incidence/prevalence of breast cancer-related lymphoedema. Two investigators independently selected articles to extract relative data and calculate corresponding exact binomial 95% confidence intervals. In total, 93 articles were reviewed, from which 19 studies were selected. The extracted data were pooled using a random-effects mixed model.
RESULTS: The incidence of lymphedema in the selected studies ranged from 3% to 36.7%, with a pooled incidence of 14.29% (95% confidence interval: 13.79-14.79). The summary odds ratio/risk ratio of axillary lymph node dissection vs. no-axillary lymph node dissection was 3.67 (95% confidence interval: 2.25-5.98) with a heterogeneity (I2) of 81% (P<0.00001). After excluding the studies with an abnormally high risk of lymphedema from self-reporting, the summary hazard ratio was 2.99 (95% confidence interval: 2.44-3.66) with no heterogeneity (I2=0%, P=0.83). The summary odds ratio/risk ratio of patients with vs. without radiotherapy was 1.82 (95% confidence interval: 0.92-3.59), but the risk ratio of radiotherapy to breast/chest vs. both axillary and supraclavicular areas was 2.66 (95% confidence interval: 0.73-9.70).
CONCLUSION: Regional nodal irradiation has a significantly higher risk for developing lymphedema than irradiation of the breast/chest wall. Axillary dissection and axillary radiotherapy have a similar risk for early-onset of breast cancer-related lymphoedema, although the risk trends higher for axillary dissection.
KEYWORDS: Breast cancer-related lymphoedema; Loco-regional therapy; Risk factor; Sentinel lymph node biopsy; Regional nodal irradiation; Axillary lymph node dissection
DOI: 10.1007/s12282-021-01263-8