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Abstract：
BACKGROUND: Triple-negative breast cancer (TNBC) is a life-threatening subtype of breast cancer with limited treatment options. Therefore, this network meta-analysis (NMA) aimed to evaluate and compare the effect of various neoadjuvant chemotherapy (NCT) options on the long-term survival of patients with TNBC.
METHODS: PubMed, Embase, Medline, Cochrane Library, Web of Science, and major international conference databases were systematically searched for randomized controlled trials (RCTs) on the efficacy of various NCT options in patients with TNBC. Searches were performed from January 2000 to June 2023. Study heterogeneity was assessed using the I2 statistic. Hazard ratios (HRs) and 95% confidence intervals (CIs) were used to evaluate disease-free survival (DFS) and overall survival (OS). Odds ratios (ORs) and 95% CIs were used to evaluate the pathologic complete response (pCR). The primary outcome was DFS.
RESULTS: We conducted an NMA of 21 RCTs involving 8873 patients with TNBC. Our study defined the combination of anthracyclines and taxanes as the preferred treatment option. On this basis, the addition of any of the following new drugs is considered a new treatment option: bevacizumab (B), platinum (P), poly-ADP-ribose polymerase inhibitors (PARPi), and immune checkpoint inhibitor (ICI). Based on the surface under the cumulative ranking curve (SUCRA) values, the top three SUCRA area values of DFS were taxanes, anthracycline, and cyclophosphamide (TAC; 89.23%); CT (84.53%); and B (81.06%). The top three SUCRA area values of OS were CT (83.70%), TAC (62.02%), and B-containing regimens (60.06%). The top three SUCRA area values of pCR were B + P-containing regimens (82.7%), ICI + P-containing regimens (80.2%), and ICI-containing regimens (61.8%).
CONCLUSIONS: This NMA showed that standard chemotherapy is a good choice with respect to long-term survival. Moreover, B associated with P-containing regimens is likely to be the optimal treatment option for neoadjuvant TNBC in terms of pCR.
METHODS: PubMed, Embase, Medline, Cochrane Library, Web of Science, and major international conference databases were systematically searched for randomized controlled trials (RCTs) on the efficacy of various NCT options in patients with TNBC. Searches were performed from January 2000 to June 2023. Study heterogeneity was assessed using the I2 statistic. Hazard ratios (HRs) and 95% confidence intervals (CIs) were used to evaluate disease-free survival (DFS) and overall survival (OS). Odds ratios (ORs) and 95% CIs were used to evaluate the pathologic complete response (pCR). The primary outcome was DFS.
RESULTS: We conducted an NMA of 21 RCTs involving 8873 patients with TNBC. Our study defined the combination of anthracyclines and taxanes as the preferred treatment option. On this basis, the addition of any of the following new drugs is considered a new treatment option: bevacizumab (B), platinum (P), poly-ADP-ribose polymerase inhibitors (PARPi), and immune checkpoint inhibitor (ICI). Based on the surface under the cumulative ranking curve (SUCRA) values, the top three SUCRA area values of DFS were taxanes, anthracycline, and cyclophosphamide (TAC; 89.23%); CT (84.53%); and B (81.06%). The top three SUCRA area values of OS were CT (83.70%), TAC (62.02%), and B-containing regimens (60.06%). The top three SUCRA area values of pCR were B + P-containing regimens (82.7%), ICI + P-containing regimens (80.2%), and ICI-containing regimens (61.8%).
CONCLUSIONS: This NMA showed that standard chemotherapy is a good choice with respect to long-term survival. Moreover, B associated with P-containing regimens is likely to be the optimal treatment option for neoadjuvant TNBC in terms of pCR.
摘要：
背景：三阴性乳腺癌（TNBC）是一种威胁生命的乳腺癌亚型，治疗选择有限。因此,本网络荟萃分析(NMA)旨在评估和比较不同新辅助化疗(NCT)方案对TNBC患者长期生存的影响.
方法：PubMed，Embase,Medline,科克伦图书馆,WebofScience,和主要的国际会议数据库被系统地搜索关于不同NCT方案在TNBC患者中的疗效的随机对照试验(RCT).从2000年1月至2023年6月进行了搜索。使用I2统计量评估研究异质性。使用危险比（HR）和95％置信区间（CIs）评估无病生存率（DFS）和总生存率（OS）。使用赔率比（OR）和95％CI来评估病理完全缓解（pCR）。主要结果是DFS。
结果：我们对21个RCT进行了NMA检查，包括8873例TNBC患者。我们的研究将蒽环类和紫杉烷类的组合定义为首选治疗方案。在此基础上,添加以下任何一种新药都被认为是一种新的治疗选择：贝伐单抗（B），铂（P），聚ADP-核糖聚合酶抑制剂（PARPi），和免疫检查点抑制剂（ICI）。根据累积排名曲线(SUCRA)下的曲面值，DFS的前三个SUCRA面积值是紫杉烷，蒽环类药物,和环磷酰胺(TAC;89.23%);CT(84.53%);和B(81.06%)。OS前3位的SUCRA面积值分别为CT(83.70%),TAC（62.02%），和含B方案（60.06%）。pCR的SUCRA面积值排名前3位的是含B+P方案(82.7%),ICI+含P方案（80.2%），和含ICI的方案(61.8%)。
结论：该NMA显示标准化疗是长期生存的良好选择。此外，就pCR而言，与含P方案相关的B可能是新辅助TNBC的最佳治疗选择。
方法：PubMed，Embase,Medline,科克伦图书馆,WebofScience,和主要的国际会议数据库被系统地搜索关于不同NCT方案在TNBC患者中的疗效的随机对照试验(RCT).从2000年1月至2023年6月进行了搜索。使用I2统计量评估研究异质性。使用危险比（HR）和95％置信区间（CIs）评估无病生存率（DFS）和总生存率（OS）。使用赔率比（OR）和95％CI来评估病理完全缓解（pCR）。主要结果是DFS。
结果：我们对21个RCT进行了NMA检查，包括8873例TNBC患者。我们的研究将蒽环类和紫杉烷类的组合定义为首选治疗方案。在此基础上,添加以下任何一种新药都被认为是一种新的治疗选择：贝伐单抗（B），铂（P），聚ADP-核糖聚合酶抑制剂（PARPi），和免疫检查点抑制剂（ICI）。根据累积排名曲线(SUCRA)下的曲面值，DFS的前三个SUCRA面积值是紫杉烷，蒽环类药物,和环磷酰胺(TAC;89.23%);CT(84.53%);和B(81.06%)。OS前3位的SUCRA面积值分别为CT(83.70%),TAC（62.02%），和含B方案（60.06%）。pCR的SUCRA面积值排名前3位的是含B+P方案(82.7%),ICI+含P方案（80.2%），和含ICI的方案(61.8%)。
结论：该NMA显示标准化疗是长期生存的良好选择。此外，就pCR而言，与含P方案相关的B可能是新辅助TNBC的最佳治疗选择。
