目的:确定激素受体阳性绝经后早期乳腺癌(EBC)患者辅助内分泌治疗的最佳初始5年。方法:我们对PubMed进行了系统的搜索,WebofScience,和EMBASE获得2000年1月至2022年1月发表的相关研究。纳入评估最初5年辅助内分泌治疗的疗效和安全性的随机临床试验。主要结局是无病生存率和总生存率,次要结局是严重不良反应(SAEs)。进行贝叶斯网络荟萃分析以间接比较所有方案,并使用累积排名曲线(SUCRA)下的表面值获得排名。结果:共纳入11项研究,包括49,987名受试者。对于DFS,依西美坦(EXE)[风险比(HR)0.91,95%置信区间(95CI)0.87-0.96],阿那曲唑(ANA)(0.94,0.90-0.97),来曲唑(LET)(0.93,0.89-0.97),他莫昔芬(TAM),然后是EXE(0.91,0.87-0.96),TAM其次是ANA(0.92,0.87-0.98)比TAM更有利,TAM紧随其后的是EXE,在SUCRA中排名第一。对于操作系统,仅TAM和ANA显示出比TAM显著的优势(HR0.91,95CI0.86-0.97),在SUCRA中排名第一。对于SAE,EXE(HR1.72,95CI1.04-2.98),ANA(1.58,1.03-2.43),与TAM相比,LET(1.63,1.02-2.57)与骨折的相关性更大。然而,心脏事件的发生率没有显着差异,血栓栓塞事件,在所有比较中都发现了脑血管事件。结论:序贯使用芳香化酶抑制剂,疗效最好,副作用相对较轻,可能是激素受体阳性绝经后EBC患者的最佳治疗模式。此外,三种芳香化酶抑制剂的疗效大致相当,但引起不同类型的SAE。系统审查注册:[网站],标识符[注册号]。
Purpose: To identify the optimal initial 5 years of adjuvant endocrine therapy for hormone receptor-positive postmenopausal early breast cancer (EBC) patients. Methods: We conducted a systematic search of the PubMed, Web of Science, and EMBASE to obtain relevant studies published between January 2000 and January 2022. Randomized clinical trials assessing the efficacy and safety of initial 5 years of adjuvant endocrine therapy were included. The primary outcomes were disease-free survival and overall survival and the secondary outcome was severe adverse effects (SAEs). A Bayesian network meta-analysis was carried out to indirectly compare all regimens and the value of surface under the cumulative ranking curve (SUCRA) was used to obtain rankings. Results: Eleven studies with 49,987 subjects were included. For DFS, exemestane (EXE) [hazard ratio (HR) 0.91, 95% confidence interval (95%CI) 0.87-0.96], anastrozole (ANA) (0.94, 0.90-0.97), letrozole (LET) (0.93, 0.89-0.97), tamoxifen (TAM) followed by EXE (0.91, 0.87-0.96), and TAM followed by ANA (0.92, 0.87-0.98) were more favorable than TAM, with TAM followed by EXE ranking as the first of SUCRA. For OS, only TAM followed by ANA showed significant superiority than TAM (HR 0.91, 95%CI 0.86-0.97) and ranked as the first of SUCRA. For SAEs, EXE (HR 1.72, 95%CI 1.04-2.98), ANA (1.58, 1.03-2.43), and LET (1.63, 1.02-2.57) showed greater associations with bone fracture than TAM. However, no significant difference in the incidences of cardiac events, thromboembolic events, and cerebrovascular events was found among all comparisons. Conclusion: The sequential use of aromatase inhibitors, which has the best curative effects and relatively mild side effects, may be the optimal treatment mode for hormone receptor-positive postmenopausal EBC patients. In addition, the three kinds of aromatase inhibitors achieved roughly equal efficacy, but caused different types of SAEs. Systematic
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