宫内放置曼月乐对乳腺癌术后服用他莫昔芬患者子宫内膜的影响及安全性的Meta分析

Effect and safety of intrauterine placement of Mirena on endometrium of breast cancer patients with oral administration of tamoxifen after surgery:a Meta-analysis

目的系统评价宫内放置曼月乐对乳腺癌术后口服他莫昔芬患者子宫内膜的影响及安全性。方法计算机检索中国知网、中国生物医学文献数据库、万方数据库、中文科技期刊全文数据库、PubMed、Embase、Web of Science和Cochrane Library,纳入有关乳腺癌术后服用口服他莫昔芬的女性患者宫内放置曼月乐治疗的随机对照试验。提取相关数据并评价文献质量后,运用RevMan5.4.1软件进行Meta分析。结果共纳入12篇文献,包括1072例患者。Meta分析结果显示,与单纯口服他莫昔芬治疗相比,口服他莫昔芬联合宫内放置曼月乐可降低患者子宫内膜增生和子宫内膜息肉的发生率(均P<0.05),但会提高异常阴道出血率(均P<0.05);两种治疗方法的子宫肌瘤发生率、乳腺癌复发率及乳腺癌相关死亡率差异均无统计学意义(均P>0.05)。结论与单纯口服他莫昔芬治疗相比,乳腺癌术后口服他莫昔芬联合宫内放置曼月乐可降低患者的子宫内膜增生、子宫内膜息肉的发生率,提高阴道异常出血率,但对子宫肌瘤发生率、乳腺癌复发率及乳腺癌相关死亡率可能无影响。

Objective To systematically evaluate the effect and safety of intrauterine placement of Mirena on endometrium of breast cancer patients with oral administration of tamoxifen after surgery.Methods A computer-based retrieval was conducted in CNKI,CBM,Wanfang Data,CSTJ,PubMed,Embase,Web of science and the Cochrane Library databases to enroll the randomized controlled trials about the therapies of intrauterine placement of Mirena for female breast cancer patients with oral administration of tamoxifen after surgery.After the relevant data extraction and the assessment on literature quality,RevMan5.4.1 software was employed to perform a Meta-analysis.Results Totally 12 articles were included,involving 1072 patients.The results of the Meta-analysis showed that,compared with the monotherapy of oral administration of tamoxifen,oral administration of tamoxifen combined with intrauterine placement of Mirena could reduce the incidence rates of endometrial hyperplasia and endometrial polyps in the patients(all P<0.05),but could increase the rate of abnormal vaginal bleeding(all P<0.05);there was no statistically significant difference between the two therapies in the incidence rate of hysteromyoma,recurrence rate of breast cancer,or breast cancer-related mortality(all P>0.05).Conclusion As compared with the monotherapy of oral administration of tamoxifen,oral administration of tamoxifen combined with intrauterine placement of Mirena after surgery could reduce the incidence rate of endometrial hyperplasia or endometrial polyps and increase the rate of abnormal vaginal bleeding in patients with breast cancer,but might not affect the incidence rate of hysteromyoma,recurrence rate of breast cancer,and breast cancer-related mortality.