绝经后雌激素受体阳性早期乳腺癌不同辅助内分泌治疗方案发生骨折风险的网络Meta分析

发布时间：2018-09-06 08:06

【摘要】：目的应用网络Meta分析方法,比较三种辅助内分泌治疗方案[芳香化酶抑制剂(AI)单药方案、他莫昔芬单药方案和他莫昔芬序贯AI方案]治疗绝经后雌激素受体阳性的早期乳腺癌后,患者发生骨折风险的差异。方法按照检索策略,计算机检索Pub Med、Medline、中国生物医学文献数据库、万方数据库等采用辅助内分泌方案治疗绝经后雌激素受体阳性的早期乳腺癌患者的相关文献,主要终点为骨折事件。利用Cochrane风险偏倚评估工具进行文献质量评价。应用STATA12.0软件进行传统Meta分析,应用R软件Gemtc程序包进行贝叶斯网络Meta分析,比较不同辅助内分泌治疗方案治疗后患者发生骨折的风险差异。结果最终纳入14项研究。传统Meta分析结果显示,AI单药方案与他莫昔芬单药方案间的骨折风险无明显差异(OR=1.15,95%CI为0.85~1.57),但与安慰剂相比则骨折的风险显著增加(OR=1.31,95%CI为1.09~1.56);与他莫昔芬单药方案相比,他莫昔芬序贯AI方案的骨折风险明显升高(OR=1.23,95%CI为1.05~1.45,P=0.011)。网络Meta分析结果显示,与他莫昔芬单药方案及安慰剂比较,AI单药方案显著增加骨折的风险(OR=1.43,95%Cr I为1.16~1.75;OR=1.33,95%Cr I为1.06~1.69);与他莫昔芬单药方案相比,他莫昔芬序贯AI方案则没有增加骨折的风险(OR=1.16,95%Cr I为0.95~1.43)。直接比较和间接比较结果一致。统计学未检测到异质性,并且无发表偏倚。结论对于绝经后雌激素受体阳性的早期乳腺癌患者,他莫昔芬单药方案及他莫昔芬序贯AI方案作为辅助内分泌治疗方案均未增加骨折风险;他莫昔芬序贯AI方案在具有同等疗效的情况下,不增加骨折风险,可作为辅助内分泌治疗的优先选择方案。
[Abstract]:Objective to compare three adjuvant endocrine therapy regimen [aromatase inhibitor (AI) single drug regimen] by using network Meta assay. Tamoxifen single-drug regimen and tamoxifen sequential AI regimen were used to treat postmenopausal early breast cancer with estrogen receptor positive. Methods according to the retrieval strategy, Pub Med,Medline, Chinese biomedical literature database and Wanfang database were searched by computer for the treatment of postmenopausal early breast cancer patients with estrogen receptor positive by adjuvant endocrine regimen. The main end point was fracture events. The Cochrane risk bias assessment tool was used to evaluate the literature quality. The traditional Meta analysis with STATA12.0 software and Bayesian network Meta analysis with R software Gemtc package were used to compare the risk of fracture in patients with different adjuvant endocrine therapy. The results were eventually included in 14 studies. The results of traditional Meta analysis showed that there was no significant difference in fracture risk between single drug regimen and tamoxifen regimen (OR=1.15,95%CI = 0.85 卤1.57), but the risk of fracture was significantly increased compared with placebo regimen (OR=1.31,95%CI = 1.091.56), and was significantly higher than that of tamoxifen regimen. Tamoxifen sequential AI regimen significantly increased fracture risk (OR=1.23,95%CI = 1.051.45 P0. 011). The results of network Meta analysis showed that compared with tamoxifen monotherapy regimen and placebo regimen, AI regimen significantly increased the risk of fracture (OR=1.43,95%Cr I was 1.16 ~ 1.75) and Cr I was 1.066 ~ 1.69, compared with tamoxifen monotherapy regimen, and compared with tamoxifen monotherapy regimen. Tamoxifen sequential AI regimen did not increase the risk of fracture (OR=1.16,95%Cr I = 0.95v 1.43). The results of direct and indirect comparisons are consistent. No heterogeneity was detected in statistics and there was no publication bias. Conclusion both tamoxifen monotherapy and tamoxifen sequential AI regimen as adjuvant endocrine therapy do not increase fracture risk in postmenopausal patients with early breast cancer with estrogen receptor positive. Tamoxifen sequential AI regimen can be used as a priority for adjuvant endocrine therapy without increasing fracture risk with the same efficacy.
【作者单位】：广西医科大学第二附属医院;
【分类号】：R737.9

【参考文献】