新辅助内分泌治疗早期乳腺癌的手术疗效：荟萃分析。
Surgical outcomes of neoadjuvant endocrine treatment in early breast cancer: meta-analysis.
机构信息
Cancer Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton, UK.
Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
出版信息
BJS Open. 2024 Sep 3;8(5). doi: 10.1093/bjsopen/zrae100.
BACKGROUND
Neoadjuvant endocrine therapy presents an important downstaging option with lower toxicity than neoadjuvant chemotherapy in oestrogen receptor (ER)-positive early breast cancer. Meta-analysis of the effects of neoadjuvant endocrine therapy on surgical outcomes across randomized clinical trials (RCTs) and cohort studies has not previously been performed.
METHODS
A systematic review and meta-analysis was performed to evaluate the effect of neoadjuvant endocrine therapy on surgical outcomes (PROSPERO (international prospective register of systematic reviews, 2020)) compared with surgery followed by adjuvant endocrine therapy. PubMed and EMBASE were searched to identify RCT and cohort studies between 1946 and 27 March 2024. Two independent reviewers manually screened the identified records and extracted the data. Risk of bias was assessed using the Cochrane Collaboration tools and random-effects meta-analysis was done with ReviewManager.
RESULTS
The search identified 2390 articles eligible for screening. The review included 20 studies (12 cohort and 8 RCTs); 19 were included in the meta-analysis with a total of 6382 patients. Overall, neoadjuvant endocrine therapy was associated with a lower mastectomy rate compared with surgery first (risk ratio (RR) 0.53, 95% c.i. 0.44 to 0.64). Subgroup analysis showed similar improvement in the mastectomy rate in the neoadjuvant endocrine therapy group versus control group irrespective of study type (RCT: RR 0.58, 95% c.i. 0.50 to 0.66; cohorts: RR 0.48, 95% c.i. 0.33 to 0.70). There was no difference in the mastectomy rate by duration of neoadjuvant endocrine therapy (more than 4 months: RR 0.57, 95% c.i. 0.42 to 0.78; 4 months or less than 4 months: RR 0.52, 95% c.i. 0.43 to 0.64). Most of the studies were characterized by moderate-quality evidence with significant heterogeneity.
CONCLUSION
Neoadjuvant endocrine therapy is associated with a reduction in mastectomy rate. Given the moderate methodological quality of previous studies, further RCTs are required.
REGISTRATION ID
CRD42020209257.
背景
新辅助内分泌治疗在雌激素受体（ER）阳性早期乳腺癌中比新辅助化疗具有更低的毒性和更重要的降期作用。此前尚未对新辅助内分泌治疗对随机临床试验（RCT）和队列研究的手术结果的影响进行荟萃分析。
方法
系统评价和荟萃分析评估了新辅助内分泌治疗（PROSPERO（国际前瞻性系统评价注册中心，2020 年））与辅助内分泌治疗后手术相比对手术结果的影响。检索了 1946 年至 2024 年 3 月 27 日的 PubMed 和 EMBASE，以确定 RCT 和队列研究。两名独立的审查员手动筛选确定的记录并提取数据。使用 Cochrane 协作工具评估偏倚风险，并使用 ReviewManager 进行随机效应荟萃分析。
结果
搜索确定了 2390 篇符合筛选标准的文章。综述纳入了 20 项研究（12 项队列研究和 8 项 RCT）；其中 19 项研究纳入荟萃分析，共有 6382 名患者。总体而言，与先手术相比，新辅助内分泌治疗的乳房切除术率较低（风险比（RR）0.53，95%置信区间 0.44 至 0.64）。亚组分析表明，无论研究类型如何，新辅助内分泌治疗组与对照组相比，乳房切除术率均有类似的改善（RCT：RR 0.58，95%置信区间 0.50 至 0.66；队列：RR 0.48，95%置信区间 0.33 至 0.70）。新辅助内分泌治疗的持续时间对乳房切除术率没有影响（超过 4 个月：RR 0.57，95%置信区间 0.42 至 0.78；4 个月或少于 4 个月：RR 0.52，95%置信区间 0.43 至 0.64）。大多数研究的证据质量为中等，存在显著异质性。
结论
新辅助内分泌治疗与降低乳房切除术率相关。鉴于先前研究的方法学质量中等，需要进一步的 RCT。
登记号
CRD42020209257。
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