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乳腺癌术后持续性疼痛的发生率及强度：系统回顾与meta分析
翻译：佟睿 编辑：冯玉蓉 审校：曹莹
背景：乳腺癌术后持续性疼痛(PPSP)的发生率和强度尚不确定。为了进一步阐明这一问题，我们进行了系统综述和meta分析。
方法：我们搜索了MEDLINE、EMBASE、CINAHL和pshcINFO中从最初建库到2018年11月有关于乳腺癌术后持续性疼痛(≥3个月)的观察性研究的文章。我们使用随机效应meta分析和推荐、评估、发展、评价分级方法（GRADE分级法）对证据质量进行评级。
结果：我们纳入了187项观察性研究，涉及297612名乳腺癌患者。PPSP的发生率为2%~78%，中位数37%(四分位数区间：22~48%)；合并发生率为35%(95%CI 32~39%)。使用10cm视觉模拟评分评估，合并疼痛强度为3.9 cm(95%CI 3.6~4.2 cm)。中等质量证据支持PPSP发生率的亚组效应，即局限性疼痛vs任何疼痛(29% vs 44%)，中度以上疼痛vs任何疼痛(26% vs 44%)，临床医生评估疼痛vs患者报告疼痛(23% vs 36%)，以及患者是否接受前哨淋巴结活检术与腋窝淋巴结清扫(26% vs 43%)。平差分析发现，患者报告的PPSP(任何严重程度/位置)的发生率为46%(95%CI 36~56%)，患者报告的任何位置的中到重度PPSP的发生率为27%(95%CI 10~43%)。
结论：中等质量的证据表明，所有接受乳腺癌手术的女性中，几乎有一半会出现持续性术后疼痛，大约四分之一的女性会出现中到重度的持续性术后疼痛；腋窝淋巴结清扫可能会引起较高的发生率。未来的研究应该探索保留神经的腋窝淋巴结清扫术能否减少乳腺癌手术后的持续性疼痛。
原始文献来源：Li W, Jared CC, Niveditha D, et al. Prevalence and intensity of persistent post-surgical pain following breast cancer surgery: a systematic review and meta-analysis of observational studies.[J].Br J Anaesth 2020 Sep;125(3):346-357。
Prevalence and intensity of persistent post-surgical pain following breast cancer surgery: a systematic review and meta-analysis of observational studies
Abstract
Background: The prevalence and intensity of persistent post-surgical pain (PPSP) after breast cancer surgery are uncertain. We conducted a systematic review and meta-analysis to further elucidate this issue.
Methods: We searched MEDLINE, Embase, CINAHL, and PsycINFO, from inception to November 2018, for observational studies reporting persistent pain (?3 months) after breast cancer surgery. We used random-effects meta-analysis and the Grading of Recommendations, Assessment, Development and Evaluations approach to rate quality of evidence.
Results: We included 187 observational studies with 297 612 breast cancer patients. The prevalence of PPSP ranged from 2% to 78%, median 37% (inter-quartile range: 22－48%); the pooled prevalence was 35% (95% confidence interval [CI]:32－39%). The pooled pain intensity was 3.9 cm on a 10 cm visual analogue scale (95% CI: 3.6－4.2 cm). Moderate-quality evidence supported the subgroup effects of PPSP prevalence for localized pain vs any pain (29% vs 44%), moderate or greater vs any pain (26% vs 44%), clinician-assessed vs patient-reported pain (23% vs 36%), and whether patients underwent sentinel lymph node biopsy vs axillary lymph node dissection (26% vs 43%). The adjusted analysis found that the prevalence of patient-reported PPSP (any severity/location) was 46% (95% CI: 36－56%), and the prevalence of patient-reported moderate-to-severe PPSP at any location was 27% (95% CI: 10－43%).
Conclusions: Moderate-quality evidence suggests that almost half of all women undergoing breast cancer surgery develop persistent post-surgical pain, and about one in four develop moderate-to-severe persistent post-surgical pain; the higher prevalence was associated with axillary lymph node dissection. Future studies should explore whether nerve sparing for axillary procedures reduces persistent post-surgical pain after breast cancer surgery.
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