基因表達分析對早期乳癌婦女接受術後輔助性化療選擇之統合分析

The Effectiveness of Gene Expression Profiling on Decision Making for Adjuvant Chemotherapy in Women with Early-Stage Breast Cancer

蔡宜庭(Yi-Ting Tsai) ； 方素瓔(Su-Ying Fang)

《台灣醫學》 26卷3期 (2022/05) Pp. 287-301

https://doi.org/10.6320/FJM.202205_26(3).0003

摘要

使用輔助性化學治療預防早期乳癌患者癌症復發的成效，並非絕對，基因表達分析檢測可作為早期乳癌患者，面對化學治療決策之參考依據，是否有助於降低婦女選擇化療的決策衝突，尚缺乏客觀一致結果。本研究目的為了解基因表達分析檢測，對早期乳癌婦女輔助性化學治療選擇之決策衝突，與情境性焦慮的成效、以及復發分數，為高低風險組之決策衝突與焦慮的成效。搜尋2021年6月之前發表之研究，資料庫包含Embase、MEDLINE、Cochrane Library及其他來源（如google scholar）。納入文獻進行評讀，並使用comprehensive meta-analysis 2版軟體分析。共11篇研究符合，皆為單組前後測之前瞻性研究，並皆以決策衝突量表進行成效分析。統合分析結果顯示，基因表達分析檢測可有效改善決策衝突（固定模式SMD=-0.204, p＜0.001；隨機模式SMD=-0.224, p＜0.001）與情境性焦慮（SMD=-0.180, p＜0.001）。次群組分析顯示，復發分數為高風險組相較於低風險組決策衝突改善較多，情境焦慮僅在低風險組，呈現顯著降低。

關鍵字

早期乳癌 ； 化學治療 ； 基因表達分析檢測 ； 決策衝突 ； 系統性文獻回顧 ； 統合分析

並列摘要

Using adjuvant chemotherapy to prevent cancer recurrence in patients with early breast cancer is not absolute. With the development of precision medicine, gene expression profiling tests can be used as an indication for breast cancer patients to consider receiving chemotherapy. Inconsistent results on improving women's decision-making conflict required further examination. Systematic review and meta-analysis was conducted. The primary purpose was to 1) understand the effectiveness of gene expression profiling tests in the decision-making conflict about adjuvant chemotherapy for early breast cancer women, and 2) to examine the effectiveness of decision-making conflict according to the risk level by recurrence scores. The secondary purpose was examined the effectiveness of gene expression profiling tests on the state anxiety. Studies published before June 2021were searched. The database includes Embase, MEDLINE, Cochrane Library and other sources such as google scholar. Study quality was assessed using CASP (Critical Appraisal Skills Programme) and statistical analyses were performed using comprehensive meta-analysis version 2 software. A total of 11 studies were include, all of which were single-group pre and post-test studies. The results of meta-analysis showed that gene expression profiling tests can effectively improve decision-making conflicts (fixed mode SMD=-0.204, p＜0.001; random mode SMD=-0.224, p＜0.001) and state anxiety (SMD=-0.180, p＜0.001). Sub-group analysis showed that the improved decision-making conflict in the high-risk group was much more compared to the low-risk group. However, state anxiety decreased was only observed in the low-risk group.

並列關鍵字

breast cancer ； chemotherapy ； gene expression profiling test ； decision conflict ； systematic review ； meta-analysis

參考文獻

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