腋窝淋巴结清扫对老年乳腺癌患者预后的影响

发布时间：2018-07-16 17:26

【摘要】：背景:乳腺癌目前已成为女性恶性肿瘤之首,与西方国家相比,我国乳腺癌发病年龄提前约10年,主要集中于45~55岁,虽然现如今乳腺癌患者趋于年轻化,但随着人口老龄化进展,老年乳腺癌人群相应增加。目前国内外对于老年乳腺癌的年龄定义及治疗方案有着诸多争议,而对于腋窝淋巴结的处理亦存在一定意见分歧,目前研究对腋窝淋巴结清扫后是否有利于提高老年乳腺癌总生存率、减低局部复发率及远处转移率仍无统一定论。目的:探讨相比于未行腋窝淋巴结清扫的老年乳腺癌,腋窝淋巴结清扫(ALND)手术能否改善患者预后,为临床手术方案选择提供一定依据。方法:检索已发表的关于对比腋窝淋巴结清扫与未清扫对老年乳腺癌预后影响相关文献,进行数据提取后使用Meta分析软件对纳入文献进行荟萃分析,评价腋窝淋巴结清扫对老年乳腺癌术后总生存率、无病生存率、肿瘤特异死亡率、同侧腋窝复发率、局部复发率及远处转移率的影响。结果:共计纳入乳腺癌病例6943例,其中未接受ALND者1671例,接受ALND者5272例,纳入病例基本为临床诊断早期、腋窝淋巴结阴性的老年乳腺癌患者。行Meta分析后发现ALND可降低老年乳腺癌患者术后腋窝复发转移率,其合并RR值为0.12(95%CI 0.03~0.43,P=0.001),有统计学意义。但并未发现两组患者在总生存率、肿瘤特异死亡率、局部复发率及远处转移率上有明显差异。结论:对于早期的可行手术治疗的老年乳腺癌患者,腋窝淋巴结清扫并不能提高患者生存率及降低肿瘤特异死亡率。因此,对于早期老年乳腺癌患者,避免腋窝淋巴结清扫(ALND)可成为合理的手术选择方案。目前关于腋窝淋巴结清扫对老年乳腺癌预后相关文章仍较少,需待更多、更大型临床研究证实。
[Abstract]:Background: breast cancer has become the first female malignant tumor at present. Compared with the western countries, the onset age of breast cancer in China is about 10 years earlier, mainly concentrated at 45 to 55 years old, although nowadays breast cancer patients tend to be younger. However, with the aging of the population, the number of elderly breast cancer increased accordingly. At present, there are many controversies at home and abroad on the definition of age and treatment of senile breast cancer, and there are some differences of opinion on the treatment of axillary lymph nodes. Whether the axillary lymph node dissection can improve the overall survival rate of breast cancer and reduce the local recurrence rate and distant metastasis rate is still unclear. Objective: to investigate whether axillary lymph node dissection (ALND) can improve the prognosis of elderly breast cancer patients without axillary lymph node dissection. Methods: the published literatures on the prognostic effects of axillary lymph node dissection and undissection on the prognosis of elderly breast cancer were retrieved and Meta-analysis software was used for meta-analysis. To evaluate the effects of axillary lymph node dissection (axillary lymph node dissection) on the overall survival rate, disease-free survival rate, tumor-specific mortality, ipsilateral axillary recurrence rate, local recurrence rate and distant metastasis rate of elderly breast cancer. Results: a total of 6943 cases of breast cancer were included, of which 1671 cases were not accepted ALND and 5272 cases were received ALND. The patients were basically aged breast cancer patients with early clinical diagnosis and negative axillary lymph nodes. Meta-analysis showed that ALND could reduce the rate of axillary recurrence and metastasis in elderly patients with breast cancer, and the combined RR value was 0.12 (95 CI 0.03 0. 43 P0. 001), which was statistically significant. However, there was no significant difference in overall survival rate, tumor specific mortality, local recurrence rate and distant metastasis rate between the two groups. Conclusion: axillary lymph node dissection can not improve the survival rate and decrease the tumor specific mortality of the aged breast cancer patients. Therefore, to avoid axillary lymph node dissection (ALND) is a reasonable choice for early aged breast cancer patients. At present, there are few articles about axillary lymph node dissection in the prognosis of elderly breast cancer.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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