Extended adjuvant endocrine therapy in early breast cancer: a meta-analysis of published randomized trials
Extended adjuvant endocrine therapy in early breast cancer: a meta-analysis of published randomized trials
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DOI：
10.1007/s12032-017-0986-2
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发表时间：
2017-07-01
期刊：
影响因子：
3.4
通讯作者：
Refae, Ahmed A.
中科院分区：
文献类型：
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作者：
Ibrahim, Ezzeldin M.;Al-Hajeili, Marwan R.;Refae, Ahmed A.
5年的辅助内分泌治疗是雌激素受体阳性乳腺癌的标准辅助治疗，而5年以上的扩展辅助内分泌治疗（EAET）的益处仍有争议。这一争议促使本荟萃分析比较5年的辅助内分泌治疗与EAET。纳入了11项符合条件的随机对照试验，包括29，000名女性。EAET在全因死亡的总生存率（OS）方面没有优势（比值比[OR] = 0.98（95%置信区间[CI]，0.87-1.09）; P = 0.67）。另一方面，与标准治疗相比，合并效应显示EAET与乳腺癌特异性生存率的改善相关（OR = 0.87; 95%CI 0.79-0.96; P = 0.004），无病生存期（DFS）（OR = 0.87; 95%CI 0.75-0.99; P = 0.002）、疾病复发（OR = 0.76; 95%CI 0.64-0.90; P = 0.001）和对侧乳腺复发（OR = 0.74; 95%CI 0.59-0.93; P = 0.008）。在比较他莫昔芬5年与他莫昔芬超过5年的研究中，没有显示DFS或疾病复发的改善。亚组分析显示，EAET对淋巴结阳性患者的获益更大。淋巴结阳性率、研究规模和中位随访时间被确定为解释大多数已证实的数据异质性的变量。EAET应被视为淋巴结阳性的高危乳腺癌患者的首选策略;然而，无法证明其对OS的获益。
Adjuvant endocrine therapy for 5 years is the standard adjuvant treatment for estrogen receptor-positive breast cancer while the benefits of extended adjuvant endocrine therapy (EAET) beyond 5 years are still controversial. That controversy prompted this meta-analysis to compare 5 years of adjuvant endocrine therapy only versus EAET. Eligible 11 randomized, controlled trials comprising 29,000 women were included. EAET showed no advantage in overall survival (OS) from all causes mortality (odds ratio [OR] = 0.98 (95% confidence interval [CI], 0.87-1.09); P = 0.67). On the other hand, compared with standard therapy, the pooled effects showed that EAET was associated with improvement in breast cancer-specific survival (OR = 0.87; 95% CI 0.79-0.96; P = 0.004), disease-free survival (DFS) (OR = 0.87; 95% CI 0.75-0.99; P = 0.002), disease recurrence (OR = 0.76; 95% CI 0.64-0.90; P = 0.001), and contralateral breast recurrence (OR = 0.74; 95% CI 0.59-0.93; P = 0.008). Improvement in DFS or disease recurrence was not shown in studies that compared 5 years of tamoxifen versus tamoxifen beyond 5 years. Subgroup analysis showed that EAET conferred more benefit for patients with positive lymph nodes. Rates of positive lymph nodes, the study size, and the median duration of follow-up were identified as variables that explained most of the demonstrated data heterogeneity. EAET should be considered as a preferred strategy for high-risk hormone-positive early breast cancer patients with positive lymph nodes; however, the benefit on OS could not be demonstrated.