|
|||||
|
|
Geographic and Temporal Trends in the Management of Occult Primary Breast Cancer: A Systematic Review and Meta-Analysis |
|
| Authors: | Oluwadamilola M Fayanju MD MPHS Carolyn R T Stoll MPH MSW Susan Fowler MLIS Graham A Colditz MD DrPH Donna B Jeffe PhD Julie A Margenthaler MD |
| Institution: | 1. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA 2. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA 3. Becker Medical Library, Washington University School of Medicine, St. Louis, MO, USA 4. The Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA 5. Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA |
| Abstract: | BackgroundManagement of occult primary breast cancer (OPBC), including the role of magnetic resonance imaging (MRI), is controversial. We conducted a pooled analysis of OPBC patients and a meta-analysis of MRI accuracy in OPBC in order to elucidate current practices.MethodsA literature search yielded 201 studies. Patient-level data for clinically/mammographically OPBC from studies published after 1993 and from our institution were pooled; logistic regression examined associations between patient/study data and outcomes, including treatments and recurrence. We report adjusted odds ratios (OR) and 95 % confidence intervals (95 % CI) significant at 2-tailed p < 0.05. Meta-analysis included data for patients who received MRIs for workup of clinically/mammographically OPBC. We report pooled sensitivity and specificity with 95 % CIs.ResultsThe pooled analysis included 92 patients (15 studies n = 85] plus our institution n = 7]). Patients from Asia were more likely to receive breast surgery (OR = 5.98, 95 % CI = 2.02–17.65) but not chemotherapy (OR = 0.32, 95 % CI = 0.13–0.82); patients from the United States were more likely to receive chemotherapy (OR = 13.08, 95 % CI = 2.64–64.78). Patients from studies published after 2003 were more likely to receive radiotherapy (OR = 3.86, 95 % CI = 1.41–10.55). Chemotherapy recipients were more likely to have distant recurrence (OR = 9.77, 95 % CI = 1.10–87.21). More patients with positive MRIs received chemotherapy than patients with negative MRIs (10 of 12 83.3 %] vs 5 of 13 38.5 %]; p = 0.0414). In the MRI-accuracy meta-analysis (10 studies, n = 262), pooled sensitivity and specificity were 96 % (95 % CI = 91–98 %) and 63 % (95 % CI = 42–81 %), respectively.ConclusionsOPBC management varied geographically and over time. We recommend establishing an international OPBC patient registry to facilitate longitudinal study and develop global treatment standards. |
| Keywords: | |
| 本文献已被 SpringerLink 等数据库收录！ | |