Taxane-based combinations as adjuvant chemotherapy of early breast cancer: A meta-analysis of randomized trials
Taxane-based combinations as adjuvant chemotherapy of early breast cancer: A meta-analysis of randomized trials
复制标题
DOI：
10.1200/jco.2007.11.3787
复制
发表时间：
2008-01-01
影响因子：
45.3
通讯作者：
De Placido, Sabino
中科院分区：
文献类型：
--
作者：
De Laurentiis, Michele;Cancello, Giuseppe;De Placido, Sabino
目的我们对随机试验进行了荟萃分析，评估了将紫杉烷类药物纳入基于蒽环类药物的治疗方案中治疗早期乳腺癌（EBC）的疗效。我们的目的是确定这种方法是否提高无病生存期（DFS）和总生存期（OS），以及是否保持相关患者subgroup.Methods研究的好处检索PubMed数据库和主要会议的程序。我们从每个试验中提取DFS和OS的风险比（HR）和95%CI，并使用逆方差模型（inverse-variance model.Results）获得汇总估计值。合并HR估计值为0.83（95% CI，0.79至0.87; P < .00001）DFS和0.85（95% CI，0.79 ~ 0.91;风险降低不受紫杉烷类型、雌激素受体（ER）表达、腋窝转移数目的影响（N1至3 v N4+），或患者的年龄/绝经状态。敏感性分析表明，紫杉烷类与蒽环类药物联合给药，不像顺序给药，没有显着改善OS。然而，相互作用的测试表明，HR没有两种方案之间的差异（P = 0.54）。紫杉烷给药导致DFS和OS的绝对5年风险降低5%和3%。结论在蒽环类药物为基础的方案中加入紫杉烷可改善高危EBC患者的DFS和OS。DFS获益与ER表达、淋巴结受累程度、紫杉烷类型、患者年龄/绝经状态和给药方案无关。
Purpose We conducted a meta-analysis of randomized trials that evaluated the efficacy of incorporating taxanes into anthracycline-based regimens for early breast cancer (EBC). We aimed to determine whether this approach improves disease-free survival (DFS) and overall survival (OS) and whether benefits are maintained across relevant patient subgroups.Methods Studies were retrieved by searching the PubMed database and the proceedings of major conferences. We extracted hazard ratios (HR) and 95% CIs for DFS and OS from each trial and obtained pooled estimates using an inverse-variance model.Results Thirteen studies were included in the meta-analysis (N = 22,903 patients). The pooled HR estimate was 0.83 (95% CI, 0.79 to 0.87; P < .00001) for DFS and 0.85 (95% CI, 0.79 to 0.91; P < .00001) for OS. Risk reduction was not influenced by the type of taxane, by estrogen receptor (ER) expression, by the number of axillary metastases (N1 to 3 v N4+), or by the patient's age/menopausal status. Sensitivity analysis showed that taxanes given in combination with anthracyclines, unlike sequential administration, did not significantly improve OS. However, the test for interaction showed that HR did not differ between the two schedules (P = .54). Taxane administration resulted in an absolute 5-year risk reduction of 5% for DFS and 3% for OS.Conclusion The addition of a taxane to an anthracycline-based regimen improves the DFS and OS of high-risk EBC patients. The DFS benefit was independent of ER expression, degree of nodal involvement, type of taxane, age/menopausal status of patient, and administration schedule.