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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2018, Vol. 12 ›› Issue (01) : 37 -42. doi: 10.3877/cma.j.issn.1674-0807.2018.01.008

所属专题： 文献；

论著

延长辅助内分泌治疗对比5年标准治疗对雌激素受体阳性早期乳腺癌患者预后影响的Meta分析
岳丰莉1, 潘沁汶2, 邓长容1,†()   
  1. 1. 400020　重庆市红十字会医院（江北区人民医院）急诊科
    2. 400038　重庆，陆军军医大学西南医院乳腺外科
  • 收稿日期:2017-07-13 出版日期:2018-02-01
  • 通信作者: 邓长容

Extended adjuvant endocrine therapy vs five-year standard treatment for estrogen receptor-positive early breast cancer: a meta-analysis on patient prognosis

Fengli Yue1, Qinwen Pan2, Changrong Deng1,†()   

  1. 1. Department of Emergency, Red Cross Hospital of Chongqing/People's Hospital of Jiangbei District, Chongqing 400020, China
    2. Department of Breast Surgery, Southwest Hospital, Army Military Medical University, Chongqing 400038, China
  • Received:2017-07-13 Published:2018-02-01
  • Corresponding author: Changrong Deng
  • About author:
    Corresponding author: Deng Changrong, Email:
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引用本文：

岳丰莉, 潘沁汶, 邓长容. 延长辅助内分泌治疗对比5年标准治疗对雌激素受体阳性早期乳腺癌患者预后影响的Meta分析[J]. 中华乳腺病杂志(电子版), 2018, 12(01): 37-42.

Fengli Yue, Qinwen Pan, Changrong Deng. Extended adjuvant endocrine therapy vs five-year standard treatment for estrogen receptor-positive early breast cancer: a meta-analysis on patient prognosis[J]. Chinese Journal of Breast Disease(Electronic Edition), 2018, 12(01): 37-42.

目的

探讨延长辅助内分泌治疗5年以上对雌激素受体(ER)阳性早期乳腺癌患者预后的影响。

方法

检索Pubmed、Cochrane图书馆、Medline数据库、Embase数据库、中国期刊全文数据库(CNKI)及万方数据库，收集有关延长辅助内分泌治疗疗效比较的随机对照研究。按照纳入及排除标准，由2名研究人员独立进行筛选并提取相关数据，总生存率、无瘤生存率、乳腺癌特异性生存率以及复发率作为观察指标。采用RevMan 5.3软件进行Meta分析。

结果

共纳入1996—2016年11篇随机对照研究，纳入患者29 000例。对数据进行统计分析显示：相比5年辅助内分泌治疗，5年以上的治疗并不能够显著改善ER阳性早期乳腺癌患者的总生存率(OR＝1.02，95%CI：0.90～1.15, P＝0.790)，却能够改善无瘤生存率(OR＝0.87，95%CI：0.75～0.99, P＝0.040)、乳腺癌特异性生存率(OR＝0.87，95%CI：0.79～0.96, P＝0.004)以及降低复发率(OR＝0.76，95%CI：0.64～0.90, P＝0.001)。坚持5年以上辅助内分泌治疗能够使ER阳性早期乳腺癌患者受益。

结论

对于ER阳性早期乳腺癌患者，建议延长辅助内分泌治疗。

关键词: 乳腺肿瘤, 雌激素受体, 无病生存, 复发
Objective

To evaluate the efficacy of extended adjuvant endocrine therapy for over 5 years in early breast cancer patients with estrogen receptor positive.

Methods

The related clinical controlled trials in literature on the efficacy comparison between standard endocrine therapy and extended adjuvant endocrine therapy were retrieved from the databases of Pubmed, Cochrane, Medline, Embase, China National Knowledge Infrastructure (CNKI) and WanFang. The screening was independently performed by two researchers according to the inclusion and exclusion criteria. The overall survival, disease-free survival, breast cancer-specific survival and recurrence rate were analyzed as indicators. The data were extracted and a meta-analysis was performed by the RevMan 5.3 software.

Results

The 11 randomized controlled studies involving 29 000 patients from 1996 to 2016 were included for the meta-analysis. The extended adjuvant endocrine therapy for more than 5 years did not significantly improve the overall survival in the early breast cancer patients with ER positive (OR=1.02, 95%CI: 0.90-1.15, P=0.790), but it improved the disease-free survival (OR=0.87, 95%CI: 0.75-0.99, P=0.040) and breast cancer-specific survival (OR=0.87, 95%CI: 0.79-0.96, P=0.004) and reduced the recurrence rate (OR=0.76, 95%CI: 0.64-0.90, P=0.001). The early breast cancer patients with estrogen receptor positive could benefit from extended adjuvant endocrine therapy for more than 5 years.

Conclusion

For ER-positive patients with early-stage breast cancer, it is recommended to extend the adjuvant endocrine therapy for over 5 years.

Key words: Breast neoplasms, Estrogen receptor, Disease-free survival, Recurrence
图1 检索流程图
表1 纳入Meta分析的临床研究的一般资料
纳入文献 年份 终点 病例数试验组/对照组 绝经例数(治疗前/治疗后) 平均年龄(岁) 随访时间(年)
试验组 对照组 试验组 对照组
Tormey等[11] 1996 复发/DFS/BCSS/OS 73/67 57/43 53/47 NR NR 5.6
Stewart等[12] 1996 复发/DFS/BCSS/OS 173/169 23/77 27/33 64 63 6.2
Fisher等[13] 2001 复发/DFS/OS 583/569 27/73 25/74 56 56 6.8
Jakesz等[14] 2007 复发/BCSS/OS 387/469 0/100 0/100 67.8 68.5 5.2
Ingle等[15] 2008 复发/DFS/OS 2 583/2 587 0/100 0/100 62.4 62 5.3
Mamounas[16] 2008 复发/DFS/BCSS/OS 799/799 0/100 0/100 NR NR 2.5
Davies[17] 2013 复发/DFS/BCSS/OS 3 428/3 418 8/90 8/90 NR NR 7.6
Gray[18] 2013 复发/DFS/BCSS/OS 3 468/3 485 NR NR NR NR 4.2
Mamounas[19] 2016 复发/DFS/BCSS/OS 1 959/1 964 0/100 0/100 NR NR 6.9
Tjan-Heijnen[20] 2016 复发/DFS/OS 827/833 0/100 0/100 NR NR 4.1
Zdenkowski[21] 2016 DFS/OS 181/179 0/100 0/100 65 64 3.9
图2 接受延长辅助内分泌治疗与5年标准治疗的雌激素受体阳性早期乳腺癌患者的总生存率比较
图3 接受延长辅助内分泌治疗与5年标准治疗的雌激素受体阳性早期乳腺癌患者的乳腺癌特异性生存率比较
图4 接受延长辅助内分泌治疗与5年标准治疗的雌激素受体阳性早期乳腺癌患者的无瘤生存率比较
图5 接受延长辅助内分泌治疗与5年标准治疗的雌激素受体阳性早期乳腺癌患者的复发率比较
图6 11篇论文发表偏倚分析漏斗图
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