A Network Meta-Analysis of Surgical Treatment in Patients With Early Breast Cancer

Abstract

Background In early breast cancer treatment, the preferred surgical regimen remains a topic of controversy, and conventional pairwise meta-analysis cannot provide a hierarchy based on clinical trial evidence. Therefore, a network meta-analysis was performed both for direct and indirect comparisons and to assess the survival outcomes of surgical regimens. Methods Randomized clinical trials comparing different surgical regimens for the treatment of early breast cancer were identified. Overall survival (OS) and disease-free-survival (DFS) were analyzed using random-effects network meta-analysis on the hazard ratio (HR) scale and calculated as combined HRs and 95% confidence intervals (CIs). All statistical tests were two-sided. Results The network meta-analysis compared 11 different surgical regimens that consisted of 13 and 17 direct comparisons between strategies for OS (34 trials; n = 23 587 patients) and DFS (32 trials; n = 22 552 patients), respectively. The values of surface under the cumulative ranking for OS and DFS after mastectomy (M)+radiotherapy (RT) were observed to be the largest. Breast-conserving surgery (BCS)+axillary node sampling+RT almost achieved the threshold for inferiority compared with the other surgical treatment arms and was statistically significantly associated with worse OS (HR = 0.51, 95% CI = 0.24 to 0.94; HR = 0.48, 95% CI = 0.22 to 0.92; HR = 0.51, 95% CI = 0.23 to 0.96). No statistically significant difference between BCS+sentinel lymph node biopsy (SLNB)+RT vs BCS+SLNB+intraoperative RT was observed in carrying out network meta-analysis (HR = 0.95, 95% CI = 0.64 to 1.36). Conclusions M+RT is safer than other surgical regimens for the treatment of early breast cancer patients because of the favorable balance between the survival outcomes. Early breast cancer patients who receive BCS should be given SLNB and not axillary node sampling. Intraoperative RT is no better than postoperative RT in patients who receive SLNB.

Effect of breast-conserving surgery combined with sentinel lymph node biopsy and axillary preservation on the recurrence, metastasis, complications and cosmetic results of early breast cancer patients

“…Through prospective randomized trials, related studies have confirmed that BCS combined with SLNB in patients with lymph node-negative breast cancer has a better physical and psychological impact on patients than previous axillary lymph node dissection treatment, and lower occurrence rate of complications (17,18). In this study, the results showed that patients undergoing BCS combined with SLBN and axillary preservation treatment experienced significantly lower operation times, intraoperative blood loss, and extubation times than did the control group, with the quality of life after treatment being better than that of the control group; also, 93.42% of patients in the combined group gave a good or excellent rating for the postoperative cosmetic result, which as significantly higher than that given by the control group (P<0.05); no significant difference was found in the recurrence and metastasis rate compared with the control group, which was consistent with the results of previous studies (19).…”

Multiphoton microscopy for monitoring the occurrence, metastasis and therapy of breast cancer

“…Surgery is the treatment option for most breast cancer patients. Precise surgical margin determination is still a clinical problem 114,125 . MPM provides a new idea for determining the surgical margin through observing the TME.…”

GSH/pH dual response drug delivery system for photothermal enhanced gene-immunotherapy

“…1 Conventional treatment modalities encompass surgical resection, radiotherapy, and chemotherapy, yet they are prone to triggering relapse and metastasis. [2][3][4] In recent years, photothermal therapy (PTT) has garnered significant attention owing to its virtues of minimal invasiveness, high precision, and minimal harm to healthy tissues. [5][6][7][8][9] During laser irradiation, photothermal agents (PTAs) effectively convert near-infrared (NIR) laser energy into localized heat, resulting in swift tumor ablation.…”