延长内分泌治疗在激素受体阳性早期乳腺癌治疗中的获益分析  

Benefit analysis of prolonged endocrine therapy in the treatment of hormone receptor positive early breast cancer:Meta analysis

作　　者：曾星升 刘磊[1] 易呈浩 王安安[1] 罗永辉[1] ZENG Xing-Sheng;LIU Lei;YI Cheng-Hao;WANG An-An;LUO Yong-Hui(Department of Breast Surgery,Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院乳腺外科,江西南昌330006

出　　处：《中华肿瘤防治杂志》2021年第5期379-385,共7页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的探讨延长辅助内分泌治疗能否改善激素受体阳性早期乳腺癌患者的预后,为临床治疗方案提供参考依据。方法检索PubMed、ASCO会议和圣安东尼奥会议报告,以及相关中文数据库中2018-08-31前发表的临床研究及报告。应用RevMan 5.3软件行Meta分析。结果共纳入随机对照试验文献13篇,共计32 280例患者。Meta分析结果显示,延长内分泌治疗在总生存上没有获益(HR=0.97,95%CI:0.88~1.07,P=0.54)。延长内分泌治疗能够改善患者的无疾病生存(HR=0.81,95%CI:0.72~0.92,P=0.000 8)和乳腺癌特异性生存(HR=0.87,95%CI:0.79~0.96,P=0.004)。亚组分析,延长他莫昔芬组在总生存(HR=1.01,95%CI:0.86~1.17,P=0.93)、无疾病生存(HR=0.98,95%CI:0.81~1.17,P=0.80)上无获益,在乳腺癌特异性生存上有获益(HR=0.88,95%CI:0.80~0.97,P=0.008);延长芳香化酶抑制剂组在总生存(HR=0.96,95%CI:0.84~1.09,P=0.53)、乳腺癌特异性生存(HR=0.62,95%CI:0.36~1.07,P=0.08)上无获益,在无疾病生存(HR=0.74,95%CI:0.66~0.83,P<0.001)上有获益。但延长内分泌治疗的同时也会增加子宫内膜癌事件(OR=1.92,95%CI:1.44~2.57,P<0.001)、骨相关事件(OR=1.63,95%CI:1.44~1.84,P<0.001)的发生。结论延长使用内分泌治疗能够使激素受体阳性早期乳腺癌患者获益,同时会增加子宫内膜癌事件及骨相关事件的发生。Objective To investigate whether prolonged adjuvant endocrine therapy can improve the prognosis of early breast cancer patients with hormone receptor positive,and provide reference for clinical treatment programs.Methods Comprehensive systematic search of clinical studies and reports in PubMed,American Society of Clinical Oncology,San Antonio Breast Cancer Symposium,Chinese database,using search terms,which published until August 2018.The RevMan 5.3 software meta-analysis was used to provide by the Cochrane network.Results A total of 13 randomized controlled trials involving 32 280 patients were included.Meta-analysis results showed that the patients prolonged endocrine therapy did not benefit from total survival OS(HR=0.97,95%CI:0.88-1.07,P=0.54).On the other hand,prolonged endocrine therapy can improve disease-free survival(HR=0.81,95%CI:0.72-0.92,P=0.000 8)and breast cancer-specific survival(HR=0.87,95%CI:0.79-0.96,P=0.004)of the early breast cancer patients.Subgroup analysis,prolonged tamoxifen group in total survival OS(HR=1.01,95%CI:0.86-1.17,P=0.93),disease-free survival DFS(HR=0.98,95%CI:0.81-1.17,P=0.80),there were no benefit,and there was benefit in breast cancer-specific survival BCSS(HR=0.88,95%CI:0.80-0.97,P=0.008).Prolonged aromatase inhibitor group did not benefit from total survival OS(HR=0.96,95%CI:0.84-1.09,P=0.53),breast cancer-specific survival BCSS(HR=0.62,95%CI:0.36-1.07,P=0.08),and benefited from disease-free survival DFS(HR=0.74,95%CI:0.66-0.83,P<0.001).However,prolonged endocrine therapy could increase endometrial cancer events(OR=1.92,95%CI:1.44-2.57,P<0.001)and bone related events(OR=1.63,95%CI:1.44-1.84,P<0.000 01)at same time.Conclusion Prolonged endocrine therapy can benefit early breast cancer patients with hormone receptor-positive,but will also increase the incidence of endometrial cancer and bone related events.

关 键 词：乳腺癌 激素受体阳性 内分泌治疗延长 预后 

分 类 号：R737.9[医药卫生—肿瘤]