对影响患者报告的ARM症状的风险因素的系统审查和荟萃分析在胸癌后治疗：放射疗法影响的核算
A systematic review and meta-analysis of risk factors influencing patient-reported arm symptoms post-breast cancer treatment: Accounting for radiotherapy impact
影响因子:7.90000
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
摘要
使用EORTC QLQ-BR23问卷（BR23），使用放射治疗（RT）影响系统地审查患者报告的ARM症状（AS）的危险因素。 2024.单变量和多元分析。怀孕，复发，遥远的转移BC，启动或缺乏RT。使用关键评估技能计划（CASP）清单评估了纳入论文偏见的风险。使用风险比（RR）或标准化的平均差异（SMD）进行描述性和荟萃分析，并以95％的置信区间（CI）作为效果度量进行。如果包括i2> 50％> 50％，则应用随机效应模型。包括734个研究中的十八个，样本量范围为172至2208。通常报告的危险因素包括腋窝淋巴结清除术（ALND），乳房切除术，化学治疗，化学疗法（CT）和RT（分别为6、5、4、4、4和4研究）。在荟萃分析中，ALND是手臂疼痛的危险因素（RR [95％CI] = 1.75 [1.14; 2.71]），淋巴水肿（RR [95％CI] = 5.41 [3.48; 8.39]）和AS（SMD [95％CI] = 0.49 [0.49 [0.14; 0.83; 0.83]; RT不是危险因素，但是腋窝RT总体上显着增加，因为（SMD [95％CI] = 0.55 [0.40; 0.70]），而没有腋窝RT.Alnd和乳房切除术是患者报告为AS的主要风险因素。腋窝RT是重要的危险因素，而一般RT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.