Meta-Analysis of Breast Cancer Outcomes in Adjuvant Trials of Aromatase Inhibitors Versus Tamoxifen
Meta-Analysis of Breast Cancer Outcomes in Adjuvant Trials of Aromatase Inhibitors Versus Tamoxifen
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DOI：
10.1200/jco.2009.23.1274
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发表时间：
2010-01-20
影响因子：
45.3
通讯作者：
Peto, Richard
中科院分区：
文献类型：
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作者：
Dowsett, Mitch;Cuzick, Jack;Peto, Richard
PurposeTo进行荟萃分析的随机试验芳香化酶抑制剂（AI）相比，他莫昔芬无论是作为初始单药治疗（队列1）或后2至3年的他莫昔芬（队列2）。材料和方法提交给早期乳腺癌Trialists的协作组的数据被用于单独的荟萃分析的两个队列。主要分析涉及绝经后妇女的肿瘤报告为雌激素受体阳性。对数秩P值是双侧的。Results 1队列包括9,856例患者，平均随访5.8年。5年时，AI治疗与复发率绝对下降2.9%（SE = 0.7%）相关（AI为9.6%，他莫昔芬为12.6%; 2 P <0.00001），乳腺癌死亡率绝对下降1.1%（SE = 0.5%）无显著性（AI为4.8%，他莫昔芬为5.9%; 2 P = 0.1）。队列2包括9，015例患者，平均随访时间为3.9年。治疗分歧后3年（即，开始激素治疗后约5年），AI治疗与绝对3.1%（SE = 0.6%）复发率降低（自分歧以来，AI为5.0%，他莫昔芬为8.1%; 2 P = 0.00001）和乳腺癌死亡率绝对下降0.7%（SE = 0.3%）（自分歧以来，AI为1.7%，他莫昔芬为2.4%; 2 P = 0.02）。有没有令人信服的异质性的比例复发减少的年龄，淋巴结的状态，肿瘤分级，或孕激素受体的状态，并没有迹象表明增加非乳腺癌死亡与AIs in either cohol.ConclusionAIs产生显着降低复发率与他莫昔芬相比，无论是作为初始单药治疗或2至3年后的他莫昔芬。额外的随访将提供更明确的长期生存信息。
PurposeTo conduct meta-analyses of randomized trials of aromatase inhibitors (AIs) compared with tamoxifen either as initial monotherapy (cohort 1) or after 2 to 3 years of tamoxifen (cohort 2).Materials and MethodsData submitted to the Early Breast Cancer Trialists' Collaborative Group were used in separate meta-analyses of two cohorts. Primary analyses involve postmenopausal women with tumors reported to be estrogen receptor positive. Log-rank P values are two-sided.ResultsCohort 1 comprised 9,856 patients with a mean of 5.8 years of follow-up. At 5 years, AI therapy was associated with an absolute 2.9% (SE = 0.7%) decrease in recurrence (9.6% for AI v 12.6% for tamoxifen; 2P < .00001) and a nonsignificant absolute 1.1% (SE = 0.5%) decrease in breast cancer mortality (4.8% for AI v 5.9% for tamoxifen; 2P = .1). Cohort 2 comprised 9,015 patients with a mean of 3.9 years of follow-up. At 3 years from treatment divergence (ie, approximately 5 years after starting hormonal treatment), AI therapy was associated with an absolute 3.1% (SE = 0.6%) decrease in recurrence (5.0% for AI v 8.1% for tamoxifen since divergence; 2P = .00001) and an absolute 0.7% (SE = 0.3%) decrease in breast cancer mortality (1.7% for AI v 2.4% for tamoxifen since divergence; 2P = .02). There was no convincing heterogeneity in the proportional recurrence reduction with respect to age, nodal status, tumor grade, or progesterone receptor status and no indication of an increase in nonbreast deaths with AIs in either cohort.ConclusionAIs produce significantly lower recurrence rates compared with tamoxifen, either as initial monotherapy or after 2 to 3 years of tamoxifen. Additional follow-up will provide clearer information on long-term survival.