Mối liên hệ giữa chiều rộng rìa phẫu thuật và tái phát tại chỗ ở phụ nữ mắc Carcinoma ống dẫn tại chỗ được điều trị bằng liệu pháp bảo tồn vú: Một phân tích tổng hợp

Annals of Surgical Oncology - Tập 23 - Trang 3811-3821 - 2016
M. Luke Marinovich1, Lamiae Azizi1, Petra Macaskill1, Les Irwig1, Monica Morrow2, Lawrence J. Solin3, Nehmat Houssami1
1Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
2Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
3Department of Radiation Oncology, Albert Einstein Healthcare Network, Philadelphia, USA

Tóm tắt

Không có sự đồng thuận về sự phù hợp của chiều rộng rìa âm trong phẫu thuật bảo tồn vú (BCS) cho carcinoma ống dẫn tại chỗ (DCIS). Chúng tôi đã thực hiện một đánh giá hệ thống về bằng chứng liên quan đến chiều rộng rìa trong BCS cho DCIS. Một phân tích tổng hợp cấp độ nghiên cứu về tỷ lệ tái phát tại chỗ (LR), trạng thái rìa vi mô và khoảng cách ngưỡng cho rìa âm. Tỷ lệ LR được mô hình hóa bằng cách sử dụng hồi quy logistic có hiệu ứng ngẫu nhiên (frequentist) và phân tích mạng (Bayesian), cho phép nhiều khoảng cách rìa cho mỗi nghiên cứu và điều chỉnh theo thời gian theo dõi. Dựa trên 20 nghiên cứu (LR: 865 trong tổng số 7883), tỷ lệ LR có liên quan đến trạng thái rìa [logistic: tỷ số cược (OR) 0.53 cho rìa âm so với rìa dương/gần (p < 0.001); mạng: OR 0.45 cho rìa âm so với rìa dương]. Trong hồi quy logistic, so với >0 hoặc 1 mm, OR cho 2 mm (0.51), 3 hoặc 5 mm (0.42) và 10 mm (0.60) cho thấy sự giảm đáng kể tương tự về tỷ lệ LR. Trong phân tích mạng, OR so với rìa dương cho 2 (0.32), 3 (0.30) và 10 mm (0.32) cho thấy sự giảm tương tự về tỷ lệ LR, lớn hơn so với >0 hoặc 1 mm (0.45). Có bằng chứng yếu cho thấy tỷ lệ thấp hơn ở 2 mm so với >0 hoặc 1 mm [tỷ số cược tương đối (ROR) 0.72, khoảng tin cậy 95% (CrI) 0.47–1.08], và không có bằng chứng về sự khác biệt giữa 2 và 10 mm (ROR 0.99, CrI 95% 0.61–1.64). Việc điều chỉnh cho các yếu tố đồng có và các phân tích chỉ dựa trên các nghiên cứu sử dụng xạ trị toàn vú không thay đổi kết quả. Các rìa âm trong BCS cho DCIS làm giảm tỷ lệ LR; tuy nhiên, các khoảng cách rìa tối thiểu trên 2 mm không có liên quan đáng kể đến việc làm giảm thêm tỷ lệ LR ở phụ nữ nhận xạ trị.

Từ khóa

#phẫu thuật bảo tồn vú #carcinoma ống dẫn tại chỗ #tái phát tại chỗ #chiều rộng rìa #phân tích tổng hợp

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