Adjuvant chemotherapy, with or without taxanes, in early or operable breast cancer: a meta-analysis of 19 randomized trials with 30698 patients.
Adjuvant chemotherapy, with or without taxanes, in early or operable breast cancer: a meta-analysis of 19 randomized trials with 30698 patients.
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DOI：
10.1371/journal.pone.0026946
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发表时间：
2011
期刊：
影响因子：
3.7
通讯作者：
He J
中科院分区：
文献类型：
--
作者：
Qin YY;Li H;Guo XJ;Ye XF;Wei X;Zhou YH;Zhang XJ;Wang C;Qian W;Lu J;He J
紫杉烷类已被广泛用作早期或可手术乳腺癌的辅助化疗，特别是在高危、淋巴结阴性乳腺癌中。然而，以前的研究报告了关于其临床疗效和安全性的不一致结果。我们通过系统回顾和荟萃分析研究了紫杉烷类药物的无病生存期（DFS）、总生存期（OS）和药物相关毒性。我们系统性地检索了PubMed、EMBASE、科克伦对照试验中心注册库、主要会议记录和1980年1月至2011年4月期间进行的研究的文献参考列表。比较化疗与紫杉烷治疗早期或可手术乳腺癌患者的随机对照试验（RCT）符合纳入我们的分析。主要终点为DFS。19项随机对照试验共纳入30698例患者，包括8426例复发事件和3803例死亡。紫杉烷给药使DFS的风险比（HR）降低17%（HR = 0.83，95% CI 0.79-0.88，p<0.001），OS的HR降低17%（HR = 0.83，95% CI 0.77-0.90，p<0.001）。 对于高风险、淋巴结阴性乳腺癌，合并HR也有利于紫杉烷类药物治疗组优于无紫杉烷类药物治疗组（HR = 0.82，95% CI 0.77-0.87，p = 0.022）。 紫杉烷为基础的治疗组中性粒细胞减少症、发热性中性粒细胞减少症、疲乏、腹泻、口腔炎和水肿的发生率显著增加。紫杉烷类辅助化疗可降低早期或可手术乳腺癌患者的癌症复发和死亡风险，但应平衡药物相关毒性。此外，我们还证明了高风险，淋巴结阴性乳腺癌患者也受益于紫杉烷类药物治疗，这一结果在以前的研究中没有观察到。
Taxanes have been extensively used as adjuvant chemotherapy for the treatment of early or operable breast cancer, particularly in high risk, node-negative breast cancer. Previous studies, however, have reported inconsistent findings regarding their clinical efficacy and safety. We investigated disease-free survival (DFS), overall survival (OS), and drug-related toxicities of taxanes by a systematic review and meta-analysis. We systematically searched PubMed, EMBASE, the Cochrane Center Register of Controlled Trials, proceedings of major meetings, and reference lists of articles for studies conducted between January 1980 and April 2011. Randomized controlled trials (RCTs) comparing chemotherapy with and without taxanes in the treatment of patients with early-stage or operable breast cancer were eligible for inclusion in our analysis. The primary endpoint was DFS. Nineteen RCTs including 30698 patients were identified, including 8426 recurrence events and 3803 deaths. Taxanes administration yielded a 17% reduction of hazard ratio (HR) for DFS (HR = 0.83, 95% CI 0.79–0.88, p<0.001) and a 17% reduction of HR for OS (HR = 0.83, 95% CI 0.77–0.90, p<0.001). For high risk, node-negative breast cancer, the pooled HR also favoured the taxane-based treatment arm over the taxane-free treatment arm (HR = 0.82, 95% CI 0.77–0.87, p = 0.022). A significantly increased rate of neutropenia, febrile neutropenia, fatigue, diarrhea, stomatitis, and oedema was observed in the taxane-based treatment arm. Adjuvant chemotherapy with taxanes could reduce the risk of cancer recurrence and death in patients with early or operable breast cancer, although the drug-related toxicities should be balanced. Furthermore, we also demonstrated that patients with high risk, node-negative breast cancer also benefited from taxanes therapy, a result that was not observed in previous studies.
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影响因子：
45.3
作者：
De Laurentiis, Michele;Cancello, Giuseppe;De Placido, Sabino
通讯作者：
De Placido, Sabino
影响因子：
45.3
作者：
Henderson, IC;Berry, DA;Norton, L
通讯作者：
Norton, L
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
11.5
作者：
Gianni, L;Baselga, J;Bonadonna, G
通讯作者：
Bonadonna, G
影响因子：
105.7
作者：
Higgins, JPT;Thompson, SG;Altman, DG
通讯作者：
Altman, DG