促性腺激素释放激素类似物联合化疗治疗绝经前早期乳腺癌患者Meta分析
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摘要
[目的]系统评价促性腺激素释放激素类似物联合化疗治疗早期绝经前乳腺癌患者的有效性。[方法]数据库检索国内外1996～2018年发表的促性腺激素释放激素类似物(gonadotropin-releasing hormone analog,GnRHa)联合化疗治疗早期绝经前乳腺癌患者的前瞻性随机对照临床试验研究,对符合纳入标准的研究使用Jadad评分进行文献质量评价,并使用STATA 12.0软件进行meta分析。[结果]共纳入5项Ⅲ期随机对照临床试验。Meta分析结果显示,与单纯化疗相比,GnRHa联合化疗治疗早期绝经前乳腺癌患者不能延长其无病生存期(HR=0.880,95%CI:0.769～1.006,P=0.06),但能延长总生存期(HR=0.808,95%CI:0.660～0.988,P=0.038)。[结论 ] GnRHa联合化疗治疗早期绝经前乳腺癌患者优于单纯化疗,但尚需要进一步研究。
[Objective] To systematically evaluate the efficacy of gonadotropin-releasing hormone analog(GnRHa) combined with adjuvant chemotherapy in premenopausal women with early stage breast cancer. [Methods] The prospective random control trials comparing adjuvant chemotherapy with or without GnRHa for premenopausal women with early stage breast cancer published in the domestic and overseas during 1996 to 2018 were searched. Jadad grading standard was used to appraise the quality of the included studies. STATA 12.0 was used to conduct the Meta-analysis. [Results] With 5 eligible phaseⅢ randomized controlled clinical trials identified,the analysis demonstrated that premenopausal women with early stage breast cancer did not benefit in disease-free survival(DFS)(HR=0.880,95% CI:0.769～1.006,P=0.06],but derived benefit in overall survival(HR=0.808,95%CI:0.660～0.988,P=0.038] from the addition of GnRHa to adjuvant chemotherapy. [Conclusion] GnRHa combined withadjuvant chemotherapy may improve the overall survival for premenopausal patients with early stage breast cancer.
[Objective] To systematically evaluate the efficacy of gonadotropin-releasing hormone analog(GnRHa) combined with adjuvant chemotherapy in premenopausal women with early stage breast cancer. [Methods] The prospective random control trials comparing adjuvant chemotherapy with or without GnRHa for premenopausal women with early stage breast cancer published in the domestic and overseas during 1996 to 2018 were searched. Jadad grading standard was used to appraise the quality of the included studies. STATA 12.0 was used to conduct the Meta-analysis. [Results] With 5 eligible phaseⅢ randomized controlled clinical trials identified,the analysis demonstrated that premenopausal women with early stage breast cancer did not benefit in disease-free survival(DFS)(HR=0.880,95% CI:0.769～1.006,P=0.06],but derived benefit in overall survival(HR=0.808,95%CI:0.660～0.988,P=0.038] from the addition of GnRHa to adjuvant chemotherapy. [Conclusion] GnRHa combined withadjuvant chemotherapy may improve the overall survival for premenopausal patients with early stage breast cancer.
引文
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[14]Moore HC,Unger JM,Phillips KA,et al.Goserelin for ovarian protection during breast-cancer adjuvant chemotherapy[J].N Engl J Med,2015,372(10):923-932.
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[16]Cochrane library.Cochrane Handbook for Systematic Reviews of Interventions[M].John Wiley&Sons,2008.
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[2]Zuo TT.The analysis of the research progress in the population of breast cancers in China[J].Chinese Journal of Clinical Oncology,2016,43(14):639-642.[左婷婷.中国乳腺癌全人群生存率分析研究进展[J].中国肿瘤临床,2016,43(14):639-642.]
[3]Chen WQ,Zheng RS,Peter D.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[4]Shen KW,Shen ZZ.The current status and progress of systemic adjuvant therapis after the surgery of breast cancer[J].China Oncology,2003,13(4):293-296.[沈坤炜,沈镇宙.乳腺癌术后系统性辅助治疗的现状和进展[J].中国癌症杂志,2003,13(4):293-296.]
[5]Monica Castiglione-Gertsch,Anne O’Neill,Karen N.Adjuvant chemotherapy followed by goserelin versus either modality alone for premenopausal lymph node-negative breast cancer:a randomized trial[J].J Natl Cancer Inst,2003,95(24):1833-1845.
[6]Recchia F,Saggio G,Amiconi G,et al.Gonadotropin-releasing hormone analogues added toadjuvant chemotherapy protect ovrain function and improve clinical outcomes in young women with early breast carcinoma[J].Cancer,2006,106(3):514-523.
[7]Jankowitz RC,Mc Guire KP,Davidson NE.Optimal systemic therapy for premenopausal women with hormonerecepter positive breast cancer[J].Breast,2013,22(suppl 2):S165-S170.
[8]GoelS,Sharma R,Hamilton A,et al.The Cochrane Collaboration[M].JohnWiley&Sons,Ltd,2009.
[9]Klijn JGM,Blamey RW,Boccardo F,et al.Combined tamoxifen and luteinizing hormone-releasinghormone(LHRH)agonist versus LHRH agonist alone in premenopausal advanced breast cancer:a meta-analysis of four randomized trials[J].J Clin Oncol,2009,19(2):343-353.
[10]Sun WL,Zhao YB.The new progress of drugs of ovriansupressions for breast cancers[J].Practical Oncology Journal,2014,28(1):81-84.[孙伟玲,赵艳滨.乳腺癌药物卵巢去势新进展[J].实用肿瘤学杂志,2014,28(1):81-84.]
[11]Karlsson1 P,Sun Z,Braun D,et al.Long-term results of international breast cancer studygroup trailⅧ:adjuvant chemotherapy plus goserelin compared with either therapy alone for premonopausal patients with node-nagtive breast cancer[J].Ann Oncol,2011,22(10):2216-2226.
[12]Davidson NE,O’Neill AM,Vukov AM,et al.Chemoendocrinetherapy for premenopausal women with axillary lymphy node-positive,steroid hormone recepter-positive breast cancer:results from INT0101(E5188)[J].J Clin Oncol,2005,23(25):5973-5981.
[13]Kaufmanna M,Graf E,Jonat W,et al.Arandomised trial of goserelin versus control after adjuvant risk-adapted chemotherapy in premenopausal patients with primary breast cancer[J].Eur J Cancer,2007,43(16):2351-2358.
[14]Moore HC,Unger JM,Phillips KA,et al.Goserelin for ovarian protection during breast-cancer adjuvant chemotherapy[J].N Engl J Med,2015,372(10):923-932.
[15]Lambertini M,Boni L,Michelotti A.Ovarian suppression with triptorelin during adjuvant breast cancer chemotherapy and long-term ovarian function,pregnancies,and diease-free survival a randomized clinical trial[J].JAMA,2015,314(24):2632-2640.
[16]Cochrane library.Cochrane Handbook for Systematic Reviews of Interventions[M].John Wiley&Sons,2008.
[17]Ma J,Liu Y,Zhong LP.The application and comparison in the evalution of quality of randomized controlled trials about jadad scale and Cochrane bias risk evalution tools[J].China Journal of Oral and Maxillofacial Surgery,2012,10(5):417-422.[马捷,刘莹,钟来平.Jadad量表与Cochrane偏倚风险评估工具在随机对照试验质量评价中的应用与比较[J].中国口腔颌面外科杂志,2012,10(5):417-422.]