{"title":"早期小型乳腺癌冷冻消融术后的局部复发率和残留肿瘤率：系统回顾和荟萃分析。","authors":"Eelin Tan, Jingli Chong, Uei Pua, Ern Yu Tan, Wing Yan Mok","doi":"10.1007/s12282-024-01643-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Cryoablation is currently being investigated as a minimally invasive alternative to breast-conserving surgery. This meta-analysis investigates the local recurrence and residual tumor rates after cryoablation for small early-stage breast cancers.</p><p><strong>Methods: </strong>A systematic search was conducted on Embase, PubMed, Google Scholar, and the International Clinical Trials Registry Platform from inception to 16 June 2024. Studies of patients with breast cancers ≤ 20 mm treated with cryoablation only or cryoablation followed by surgery were included. Pooled local recurrence rates (cryoablation only) and pooled residual tumors rates (cryoablation followed by surgery) were estimated with mixed-effects models. Between-study heterogeneity was assessed using I<sup>2</sup> statistics. Where I<sup>2</sup> exceeded 50%, outlier and influence analysis, followed by sensitivity analysis excluding outliers, were conducted.</p><p><strong>Results: </strong>Twelve studies met inclusion criteria, of which 7 studies (530 female patients, 531 breast tumors) reported on patients treated with cryoablation only and 5 studies (220 female patients, 222 breast tumors) reported on patients treated with cryoablation followed by surgery. For studies on cryoablation only, pooled local recurrence rate was 1.1% (95% CI 0.42-3.03%) with low between-study heterogeneity (I<sup>2</sup> value = 0%; 95% CI 0.0-70.8%; p = 0.95). For studies on cryoablation followed by surgery, pooled residual tumor rate was 12.0% (95% CI 3.85-31.64%); however, substantial between-study heterogeneity (I<sup>2</sup> value = 76.1%; 95% CI 41.7-90.2%; p < 0.01) was present. Influence analysis revealed 1 outlier study. When this study was excluded, pooled residual tumor rate was 8.2% (95% CI 3.84-16.68%) with improvement in heterogeneity (I<sup>2</sup> value = 0%; 95% CI 0.0-84.7%; p = 0.64).</p><p><strong>Conclusion: </strong>Pooled local recurrence and residual tumor rates after cryoablation are comparable to local recurrence rates after breast-conserving therapy and re-excision rates following breast-conserving surgery, respectively. These results are encouraging but should be interpreted with caution due to lack of comparative studies.</p>","PeriodicalId":56083,"journal":{"name":"Breast Cancer","volume":null,"pages":null},"PeriodicalIF":4.0000,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Local recurrence and residual tumor rates following cryoablation for small early-stage breast cancers: systemic review and meta-analysis.\",\"authors\":\"Eelin Tan, Jingli Chong, Uei Pua, Ern Yu Tan, Wing Yan Mok\",\"doi\":\"10.1007/s12282-024-01643-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Cryoablation is currently being investigated as a minimally invasive alternative to breast-conserving surgery. This meta-analysis investigates the local recurrence and residual tumor rates after cryoablation for small early-stage breast cancers.</p><p><strong>Methods: </strong>A systematic search was conducted on Embase, PubMed, Google Scholar, and the International Clinical Trials Registry Platform from inception to 16 June 2024. Studies of patients with breast cancers ≤ 20 mm treated with cryoablation only or cryoablation followed by surgery were included. Pooled local recurrence rates (cryoablation only) and pooled residual tumors rates (cryoablation followed by surgery) were estimated with mixed-effects models. Between-study heterogeneity was assessed using I<sup>2</sup> statistics. Where I<sup>2</sup> exceeded 50%, outlier and influence analysis, followed by sensitivity analysis excluding outliers, were conducted.</p><p><strong>Results: </strong>Twelve studies met inclusion criteria, of which 7 studies (530 female patients, 531 breast tumors) reported on patients treated with cryoablation only and 5 studies (220 female patients, 222 breast tumors) reported on patients treated with cryoablation followed by surgery. For studies on cryoablation only, pooled local recurrence rate was 1.1% (95% CI 0.42-3.03%) with low between-study heterogeneity (I<sup>2</sup> value = 0%; 95% CI 0.0-70.8%; p = 0.95). For studies on cryoablation followed by surgery, pooled residual tumor rate was 12.0% (95% CI 3.85-31.64%); however, substantial between-study heterogeneity (I<sup>2</sup> value = 76.1%; 95% CI 41.7-90.2%; p < 0.01) was present. Influence analysis revealed 1 outlier study. When this study was excluded, pooled residual tumor rate was 8.2% (95% CI 3.84-16.68%) with improvement in heterogeneity (I<sup>2</sup> value = 0%; 95% CI 0.0-84.7%; p = 0.64).</p><p><strong>Conclusion: </strong>Pooled local recurrence and residual tumor rates after cryoablation are comparable to local recurrence rates after breast-conserving therapy and re-excision rates following breast-conserving surgery, respectively. These results are encouraging but should be interpreted with caution due to lack of comparative studies.</p>\",\"PeriodicalId\":56083,\"journal\":{\"name\":\"Breast Cancer\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.0000,\"publicationDate\":\"2024-10-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Breast Cancer\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s12282-024-01643-w\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Breast Cancer","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12282-024-01643-w","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：冷冻消融术目前正作为保乳手术的微创替代方法接受研究。这项荟萃分析调查了早期乳腺癌患者冷冻消融术后的局部复发率和肿瘤残留率：方法：在Embase、PubMed、Google Scholar和国际临床试验注册平台（International Clinical Trials Registry Platform）上进行了系统检索。方法：在Embase、PubM、Google学术和国际临床试验注册平台上进行了系统性检索，检索时间为2024年6月16日。采用混合效应模型估算了汇总的局部复发率（仅冷冻消融）和汇总的残留肿瘤率（冷冻消融后再手术）。研究间异质性采用I2统计量进行评估。当I2超过50%时，进行离群值和影响分析，然后进行排除离群值的敏感性分析：12项研究符合纳入标准，其中7项研究（530名女性患者，531颗乳腺肿瘤）仅报告了接受冷冻消融治疗的患者，5项研究（220名女性患者，222颗乳腺肿瘤）报告了接受冷冻消融治疗后再进行手术的患者。对于仅进行冷冻消融的研究，汇总的局部复发率为 1.1%（95% CI 0.42-3.03%），研究间异质性较低（I2 值 = 0%；95% CI 0.0-70.8%；P = 0.95）。对于冷冻消融后再手术的研究，汇总的残留肿瘤率为12.0%（95% CI 3.85-31.64%）；然而，研究间异质性很大（I2值=76.1%；95% CI 41.7-90.2%；P 2值=0%；95% CI 0.0-84.7%；P = 0.64）：结论：冷冻消融术后的汇总局部复发率和残留肿瘤率分别与保乳治疗后的局部复发率和保乳手术后的再次切除率相当。这些结果令人鼓舞，但由于缺乏对比研究，在解释这些结果时应谨慎。
Local recurrence and residual tumor rates following cryoablation for small early-stage breast cancers: systemic review and meta-analysis.
Background: Cryoablation is currently being investigated as a minimally invasive alternative to breast-conserving surgery. This meta-analysis investigates the local recurrence and residual tumor rates after cryoablation for small early-stage breast cancers.
Methods: A systematic search was conducted on Embase, PubMed, Google Scholar, and the International Clinical Trials Registry Platform from inception to 16 June 2024. Studies of patients with breast cancers ≤ 20 mm treated with cryoablation only or cryoablation followed by surgery were included. Pooled local recurrence rates (cryoablation only) and pooled residual tumors rates (cryoablation followed by surgery) were estimated with mixed-effects models. Between-study heterogeneity was assessed using I2 statistics. Where I2 exceeded 50%, outlier and influence analysis, followed by sensitivity analysis excluding outliers, were conducted.
Results: Twelve studies met inclusion criteria, of which 7 studies (530 female patients, 531 breast tumors) reported on patients treated with cryoablation only and 5 studies (220 female patients, 222 breast tumors) reported on patients treated with cryoablation followed by surgery. For studies on cryoablation only, pooled local recurrence rate was 1.1% (95% CI 0.42-3.03%) with low between-study heterogeneity (I2 value = 0%; 95% CI 0.0-70.8%; p = 0.95). For studies on cryoablation followed by surgery, pooled residual tumor rate was 12.0% (95% CI 3.85-31.64%); however, substantial between-study heterogeneity (I2 value = 76.1%; 95% CI 41.7-90.2%; p < 0.01) was present. Influence analysis revealed 1 outlier study. When this study was excluded, pooled residual tumor rate was 8.2% (95% CI 3.84-16.68%) with improvement in heterogeneity (I2 value = 0%; 95% CI 0.0-84.7%; p = 0.64).
Conclusion: Pooled local recurrence and residual tumor rates after cryoablation are comparable to local recurrence rates after breast-conserving therapy and re-excision rates following breast-conserving surgery, respectively. These results are encouraging but should be interpreted with caution due to lack of comparative studies.
期刊介绍：
Breast Cancer, the official journal of the Japanese Breast Cancer Society, publishes articles that contribute to progress in the field, in basic or translational research and also in clinical research, seeking to develop a new focus and new perspectives for all who are concerned with breast cancer. The journal welcomes all original articles describing clinical and epidemiological studies and laboratory investigations regarding breast cancer and related diseases. The journal will consider five types of articles: editorials, review articles, original articles, case reports, and rapid communications. Although editorials and review articles will principally be solicited by the editors, they can also be submitted for peer review, as in the case of original articles. The journal provides the best of up-to-date information on breast cancer, presenting readers with high-impact, original work focusing on pivotal issues.
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