不同内分泌治疗方法对激素受体阳性晚期乳腺癌患者疗效的网状Meta分析

Efficacy of different endocrine therapy for patients with hormone-sensitive advanced breast cancer:a network Meta-analysis

目的探讨不同内分泌治疗方法对激素受体(HR)阳性晚期乳腺癌患者的疗效。方法采用关键词检索PubMed、Web of Science、Embase和中国知网,检索时间自2000年1月1日至2019年12月31日,按照纳入排除标准筛选符合要求的随机对照研究,利用Stata 14.0软件进行网状Meta分析,使用哈斯排序法的结果P分数(P-score)对比不同治疗方案的优势程度,并评估患者无进展生存期(PFS)和总体生存期(OS)的差异。结果本研究共纳入英文文献20篇,其中7篇采用了联合靶向药物的内分泌治疗方法,联合靶向药物组PFS的合并效应量(HR)=0.64(95%CI:0.54~0.76);未联合靶向药物治疗组HR=0.86(95%CI:0.75~0.98);合并分析联合与未联合靶向药物治疗组的(OS)结果为HR=0.92(95%CI:0.84~1.01)。结合不良事件发生率(AE)和治疗反应率(TR),结果证明,靶向药物帕博西尼与来曲唑联合应用的疗效最好(P-score=0.99),其次为布帕利西布联合氟维司群(P-score=0.73)和单用来曲唑(P-score=0.60)。结论结合AE和TR作为筛选最优治疗方案的辅助因素,针对HR阳性晚期乳腺癌的患者,建议结合临床,在内分泌治疗的基础上,靶向药物联合治疗将有助于改善患者的PFS。

Objective This study was designed to investigate the efficacy of different endocrine therapy methods in patients with hormone receptor(HR)positive advanced breast cancer.Methods From January 1,2000 to December 31,2019,PubMed,Web of Science,Embase and CNKI databases were used to search for randomized controlled studies according to the inclusion criteria,and then the data in the literature were extracted.The network Meta-analysis was performed using Stata 14.0 software,and P-score of the Haas ranking method was used to compare the advantages of different treatment regimens,and the differences in progression-free survival(PFS)and overall survival(OS)were evaluated.Results A total of 20 english literatures were included in the study.Seven of them used endocrine therapy with a combination of targeted drugs which the combined effect(hazard ratio,HR)of PFS showed that HR was 0.64(95%CI:0.54-0.76).The group without targeted drug treatment had HR=0.86(95%CI:0.75-0.98),and the combined analysis on the OS of the combined and non-combined targeted drug treatment group showed that HR=0.92(95%CI:0.84-1.01).Combined with the adverse events(AE)and treatment response(TR),the results showed that the combination of the targeted drug Palbociclib and Letrozole was the best(P-score=0.99),followed by Buparlisib plus Fulvestrant(P-score=0.73)and single use of Letrozole(P-score=0.60).Conclusion Combining AEs and TR as co-factors for screening optimal treatment,we recommend clinically that patients with HR positive breast cancer,endocrine therapy,combined with targeted drugs can help improve PFS in patients with HR positive breast cancer.