绝经后乳腺癌患者应用AI与ER调节剂疗效和安全性的Meta分析

发布时间：2018-04-04 10:40

  本文选题：乳腺癌　切入点：芳香化酶抑制剂　出处：《河南科技大学》2017年硕士论文

【摘要】：目的:探究绝经后激素受体阳性的乳腺癌患者序贯应用他莫昔芬与第3代芳香化酶抑制剂的疗效和安全性是否优于单独应用他莫昔芬或第3代芳香化酶抑制剂。方法:计算机检索Cochrane、Pub Med、Embase、中国知网、万方等数据库,纳入关于他莫昔芬与芳香化酶抑制剂序贯治疗方案对比单药治疗方案治疗绝经后激素受体阳性乳腺癌的随机对照研究,并逐篇行质量评价,提取资料,应用风险比及优势比评估对比结果,并采用RevMan5.3软件进行数据分析。结果:根据严格的纳入排除标准,共纳入10篇文献,共22005例绝经后激素受体阳性乳腺癌患者。其中序贯治疗方案对比他莫昔芬单药治疗方案共7篇,共7592例患者;序贯治疗方案对比芳香化酶抑制剂单药治疗方案共3篇,共14413例患者。对于生存期的统计分析显示序贯方案对比他莫昔芬单药方案可明显延长患者总生存期HR=0.71(95%CI 0.52-0.98,P=0.04),和无复发生存期HR=0.60(95%CI 0.46-0.79,P=0.0003),且降低了死亡事件发生率OR=0.70(95%CI 0.59-0.83,P0.0001),远处转移事件发生率OR=0.76(95%CI 0.62-0.92,P=0.006)。但序贯方案对比芳香化酶抑制剂单药方案并没有显著改善患者生存获益,总生存期HR=1.01(95%CI 0.93-1.11,P=0.79),无病生存期HR=1.01(95%CI 0.93-1.09,P=0.89)。在不良事件中序贯治疗方案对比他莫昔芬单药方案降低了子宫内膜增生事件发生率OR=0.23(95%CI 0.11-0.46,P0.0001),子宫内膜癌事件的发生率OR=0.18(95%CI 0.04-0.82,P=0.03);且没有增加局部复发事件发生率OR=0.81(95%CI 0.62-1.05,P=0.11),生殖器官出血事件发生率OR=0.87(95%CI 0.63-1.20,P=0.40),心脏病事件发生率OR=0.91(95%CI 0.54-1.51,P=0.70),血栓/栓塞事件发生率OR=0.61(95%CI0.27-1.38,P=0.24),发热事件发生率OR=0.94(95%CI 0.77-1.15,P=0.55);但增加了骨折事件发生率OR=1.30(95%CI 1.13-1.51,P=0.0004)。序贯治疗方案对比第3代芳香化酶抑制剂单药方案可降低骨折、心脏病事件的发生率;对子宫内膜癌、死亡、局部复发事件发生率的影响无明显差别;但升高了子宫内膜增生、生殖器官出血、血栓/栓塞、远处转移、发热等事件的发生率。结论:序贯方案对比他莫西芬单药方案,有较好疗效及安全性;对比芳香化酶抑制剂单药方案,在生存获益上并无优势。
[Abstract]:Aim: to investigate the efficacy and safety of sequential tamoxifen and aromatase inhibitors in postmenopausal patients with steroid-receptor positive breast cancer compared with tamoxifen or aromatase inhibitors alone.Methods: the databases of Cochraneus Pub Medbase, China Zhiwang and Wanfang were searched by computer, and were included in a randomized controlled study on the treatment of postmenopausal hormone receptor positive breast cancer by tamoxifen and aromatase inhibitor sequential therapy.The data were extracted, the risk ratio and the advantage ratio were evaluated and compared, and the data were analyzed by RevMan5.3 software.Results: according to the strict exclusion criteria, a total of 22005 postmenopausal hormone receptor positive breast cancer patients were included in 10 articles.Among them, there were 7 sequential regimens compared with tamoxifen monotherapy (7592 cases), and 3 sequential regimens compared with aromatase inhibitors (14413 cases).瀵逛簬鐢熷瓨鏈熺殑缁熻�″垎鏋愭樉绀哄簭璐�鏂规�堝�规瘮浠栬帿鏄旇姮鍗曡嵂鏂规�堝彲鏄庢樉寤堕暱鎮ｈ�呮，

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