Childers W Kurtis, Hollenbeak Christopher S, Cheriyath Pramil
Department of Surgery, Pinnacle Health System, Harrisburg, PA.
Departments of Surgery and Public Health Sciences, Penn State College of Medicine, Hershey, PA.
Clin Breast Cancer. 2015 Dec;15(6):426-31. doi: 10.1016/j.clbc.2015.07.001. Epub 2015 Jul 10.
The normal physiologic stress mechanism, mediated by the sympathetic nervous system, causes a release of the neurotransmitters epinephrine and norepinephrine. Preclinical data have demonstrated an effect on tumor progression and metastasis via the sympathetic nervous system mediated primarily through the β-adrenergic receptor (β-AR) pathway. In vitro data have shown an increase in tumor growth, migration, tumor angiogenesis, and metastatic spread in breast cancer through activation of the β-AR. Retrospective cohort studies on the clinical outcomes of β-blockers in breast cancer outcomes showed no clear consensus. The purpose of this study was to perform a systematic review and meta-analysis of the effect of β-blockers on breast cancer outcomes. A systematic review was performed using the Cochrane library and PubMed. Publications between the dates of January 2010 and December 2013 were identified. Available hazard ratios (HRs) were extracted for breast cancer recurrence, breast cancer death, and all-cause mortality and pooled using a random effects meta-analysis. A total of 7 studies contained results for at least 1 of the outcomes of breast cancer recurrence, breast cancer death, or all-cause mortality in breast cancer patients receiving β-blockers. In the 5 studies that contained results for breast cancer recurrence, there was no statistically significant risk reduction (HR, 0.67; 95% confidence interval [CI], 0.39-1.13). Breast cancer death results were contained in 4 studies, which also suggested a significant reduction in risk (HR, 0.50; 95% CI, 0.32-0.80). Among the 4 studies that reported all-cause mortality, there was no significant effect of β-blockers on risk (HR, 1.02; 95% CI, 0.75-1.37). Results of this systematic review and meta-analysis suggest that the use of β-blockers significantly reduced risk of breast cancer death among women with breast cancer.
由交感神经系统介导的正常生理应激机制会导致神经递质肾上腺素和去甲肾上腺素的释放。临床前数据表明，通过主要由β-肾上腺素能受体（β-AR）途径介导的交感神经系统，对肿瘤进展和转移有影响。体外数据显示，通过激活β-AR，乳腺癌的肿瘤生长、迁移、肿瘤血管生成和转移扩散会增加。关于β受体阻滞剂对乳腺癌临床结局影响的回顾性队列研究尚无明确共识。本研究的目的是对β受体阻滞剂对乳腺癌结局的影响进行系统评价和荟萃分析。使用Cochrane图书馆和PubMed进行系统评价。确定了2010年1月至2013年12月期间的出版物。提取了乳腺癌复发、乳腺癌死亡和全因死亡率的可用风险比（HRs），并使用随机效应荟萃分析进行汇总。共有7项研究包含了接受β受体阻滞剂治疗的乳腺癌患者至少1项乳腺癌复发、乳腺癌死亡或全因死亡率结局的结果。在包含乳腺癌复发结果的5项研究中，没有统计学上显著的风险降低（HR，0.67；95%置信区间[CI]，0.39-1.13）。4项研究包含了乳腺癌死亡结果，这也表明风险显著降低（HR，0.50；95%CI，0.32-0.80）。在报告全因死亡率的4项研究中，β受体阻滞剂对风险没有显著影响（HR，1.02；95%CI，0.75-1.37）。这项系统评价和荟萃分析的结果表明，使用β受体阻滞剂可显著降低乳腺癌女性患者的乳腺癌死亡风险。
