Review

乳腺癌治疗后患者申报臂部症状的风险因素系统评价及荟萃分析：考虑放疗影响

A systematic review and meta-analysis of risk factors influencing patient-reported arm symptoms post-breast cancer treatment: Accounting for radiotherapy impact

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BREAST

影响因子:7.9

分区:医学2区 / 妇产科学2区肿瘤学2区

发表日期:2024 Dec

作者: Yuqin Liang, Yuedan Zhou, Ruud Houben, Karolien Verhoeven, Sofia Rivera, Liesbeth J Boersma

DOI: 10.1016/j.breast.2024.103812

摘要

本研究系统评价了乳腺癌（BC）患者申报臂部症状（AS）的风险因素，考虑放疗（RT）的影响，使用EORTC QLQ-BR23问卷（BR23）。通过检索PubMed、Embase、Cochrane图书馆、MEDLINE和Web of Science，关键词包括“乳腺肿瘤”、“放疗”和“BR23”，截止到2024年3月5日。采用单变量和多变量分析。分析中考虑孕产、复发、远处转移、再放疗或无RT等因素。采用Critical Appraisal Skills Program（CASP）工具评估纳入论文的偏倚风险。使用风险比（RR）或标准化均差（SMD）及95%的置信区间（CI）进行描述性和荟萃分析，异质性I² > 50%时采用随机效应模型。共纳入734篇研究中的18篇，样本量范围为172至2208。常见的风险因素包括腋窝淋巴结清扫（ALND）、乳房切除术、化疗（CT）和放疗（分别为6、5、4、4项研究）。荟萃分析显示，ALND是臂痛（RR[95% CI]=1.75[1.14, 2.71]）、淋巴水肿（RR[95% CI]=5.41[3.48, 8.39]）和整体臂部症状（SMD[95% CI]=0.49[0.14, 0.83]）的风险因素，相较于前哨淋巴结活检。放疗不是风险因素，但腋窝放疗显著增加整体臂部症状（SMD[95% CI]=0.55[0.40, 0.70]）相比无腋窝放疗。ALND和乳房切除术是患者申报臂部症状的主要风险因素，腋窝放疗是显著的风险因素，而全身放疗则不是。

Abstract

To systematically review risk factors for patient-reported arm symptoms (AS) in breast cancer (BC), considering radiotherapy (RT) impact, using the EORTC QLQ-BR23 questionnaire (BR23).PubMed, Embase, Cochrane Library, MEDLINE, and Web of Science were searched using the keywords "breast neoplasms", "radiotherapy", and "BR23" up to March 5th, 2024.both univariate and multivariate analyses.pregnancy, recurrence, distant metastasis BC, reirradiation, or lack of RT. The risk of bias of included papers was assessed using the Critical Appraisal Skills Program (CASP) checklist. Descriptive and meta-analyses were conducted using risk ratio (RR) or standardized mean difference (SMD) with 95 % confidence intervals (CI) as effect measures. A random-effects model was applied if I2 > 50 %.Eighteen out of 734 studies were included, with sample sizes ranging from 172 to 2208. Commonly reported risk factors included axillary lymph node dissection (ALND), mastectomy, chemotherapy (CT), and RT (6, 5, 4, and 4 studies, respectively). In meta-analyses, ALND was a risk factor for arm pain (RR [95 % CI] = 1.75 [1.14; 2.71]), lymphedema (RR [95 % CI] = 5.41 [3.48; 8.39]), and overall AS (SMD [95 % CI] = 0.49 [0.14; 0.83]) compared to sentinel lymph node biopsy. RT was not a risk factor, but axillary RT significantly increased overall AS (SMD [95 % CI] = 0.55 [0.40; 0.70]) compared to no axillary RT.ALND and mastectomy were the primary risk factors for patient-reported AS. Axillary RT was a significant risk factor, whereas general RT was not.