Surgical outcomes of neoadjuvant endocrine treatment in early breast cancer: meta-analysis.

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-09-03 DOI:10.1093/bjsopen/zrae100
Beatrice Brett, Constantinos Savva, Bahar Mirshekar-Syahkal, Martyn Hill, Michael Douek, Ellen Copson, Ramsey Cutress
{"title":"Surgical outcomes of neoadjuvant endocrine treatment in early breast cancer: meta-analysis.","authors":"Beatrice Brett, Constantinos Savva, Bahar Mirshekar-Syahkal, Martyn Hill, Michael Douek, Ellen Copson, Ramsey Cutress","doi":"10.1093/bjsopen/zrae100","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant endocrine therapy presents an important downstaging option with lower toxicity than neoadjuvant chemotherapy in oestrogen receptor (ER)-positive early breast cancer. Meta-analysis of the effects of neoadjuvant endocrine therapy on surgical outcomes across randomized clinical trials (RCTs) and cohort studies has not previously been performed.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was performed to evaluate the effect of neoadjuvant endocrine therapy on surgical outcomes (PROSPERO (international prospective register of systematic reviews, 2020)) compared with surgery followed by adjuvant endocrine therapy. PubMed and EMBASE were searched to identify RCT and cohort studies between 1946 and 27 March 2024. Two independent reviewers manually screened the identified records and extracted the data. Risk of bias was assessed using the Cochrane Collaboration tools and random-effects meta-analysis was done with ReviewManager.</p><p><strong>Results: </strong>The search identified 2390 articles eligible for screening. The review included 20 studies (12 cohort and 8 RCTs); 19 were included in the meta-analysis with a total of 6382 patients. Overall, neoadjuvant endocrine therapy was associated with a lower mastectomy rate compared with surgery first (risk ratio (RR) 0.53, 95% c.i. 0.44 to 0.64). Subgroup analysis showed similar improvement in the mastectomy rate in the neoadjuvant endocrine therapy group versus control group irrespective of study type (RCT: RR 0.58, 95% c.i. 0.50 to 0.66; cohorts: RR 0.48, 95% c.i. 0.33 to 0.70). There was no difference in the mastectomy rate by duration of neoadjuvant endocrine therapy (more than 4 months: RR 0.57, 95% c.i. 0.42 to 0.78; 4 months or less than 4 months: RR 0.52, 95% c.i. 0.43 to 0.64). Most of the studies were characterized by moderate-quality evidence with significant heterogeneity.</p><p><strong>Conclusion: </strong>Neoadjuvant endocrine therapy is associated with a reduction in mastectomy rate. Given the moderate methodological quality of previous studies, further RCTs are required.</p><p><strong>Registration id: </strong>CRD42020209257.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5000,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488384/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BJS Open","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/bjsopen/zrae100","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Neoadjuvant endocrine therapy presents an important downstaging option with lower toxicity than neoadjuvant chemotherapy in oestrogen receptor (ER)-positive early breast cancer. Meta-analysis of the effects of neoadjuvant endocrine therapy on surgical outcomes across randomized clinical trials (RCTs) and cohort studies has not previously been performed.

Methods: A systematic review and meta-analysis was performed to evaluate the effect of neoadjuvant endocrine therapy on surgical outcomes (PROSPERO (international prospective register of systematic reviews, 2020)) compared with surgery followed by adjuvant endocrine therapy. PubMed and EMBASE were searched to identify RCT and cohort studies between 1946 and 27 March 2024. Two independent reviewers manually screened the identified records and extracted the data. Risk of bias was assessed using the Cochrane Collaboration tools and random-effects meta-analysis was done with ReviewManager.

Results: The search identified 2390 articles eligible for screening. The review included 20 studies (12 cohort and 8 RCTs); 19 were included in the meta-analysis with a total of 6382 patients. Overall, neoadjuvant endocrine therapy was associated with a lower mastectomy rate compared with surgery first (risk ratio (RR) 0.53, 95% c.i. 0.44 to 0.64). Subgroup analysis showed similar improvement in the mastectomy rate in the neoadjuvant endocrine therapy group versus control group irrespective of study type (RCT: RR 0.58, 95% c.i. 0.50 to 0.66; cohorts: RR 0.48, 95% c.i. 0.33 to 0.70). There was no difference in the mastectomy rate by duration of neoadjuvant endocrine therapy (more than 4 months: RR 0.57, 95% c.i. 0.42 to 0.78; 4 months or less than 4 months: RR 0.52, 95% c.i. 0.43 to 0.64). Most of the studies were characterized by moderate-quality evidence with significant heterogeneity.

Conclusion: Neoadjuvant endocrine therapy is associated with a reduction in mastectomy rate. Given the moderate methodological quality of previous studies, further RCTs are required.

Registration id: CRD42020209257.

早期乳腺癌新辅助内分泌治疗的手术效果:荟萃分析。
背景:对于雌激素受体(ER)阳性的早期乳腺癌,新辅助内分泌治疗是一种重要的降期选择,其毒性低于新辅助化疗。此前尚未对随机临床试验(RCT)和队列研究中新辅助内分泌治疗对手术效果的影响进行荟萃分析:方法:我们进行了一项系统综述和荟萃分析,评估新辅助内分泌治疗与手术后辅助内分泌治疗相比对手术效果的影响(PROSPERO(国际前瞻性系统综述注册,2020年))。检索了 PubMed 和 EMBASE,以确定 1946 年至 2024 年 3 月 27 日期间的 RCT 和队列研究。两位独立审稿人手动筛选了已确定的记录并提取了数据。使用 Cochrane 协作工具评估了偏倚风险,并使用 ReviewManager 进行了随机效应荟萃分析:搜索共发现 2390 篇符合筛选条件的文章。综述包括 20 项研究(12 项队列研究和 8 项 RCT);19 项纳入荟萃分析,共有 6382 名患者。总体而言,与先手术相比,新辅助内分泌治疗与较低的乳房切除率相关(风险比 (RR) 0.53,95% c.i. 0.44 至 0.64)。亚组分析显示,无论研究类型如何,新辅助内分泌治疗组与对照组相比,乳房切除率都有类似的改善(RCT:RR 0.58,95% c.i.0.50-0.66;队列:RR 0.48,95% c.i.0.50-0.66):RR:0.48,95% 置信区间:0.33 至 0.70)。新辅助内分泌治疗持续时间对乳房切除率没有影响(4 个月以上:RR 0.57,95% c. i. 0.50 至 0.66;队列:RR 0.48,95% c. i. 0.33 至 0.70):RR为0.57,95% c.i.为0.42至0.78;4个月或少于4个月:RR 0.52,95% 置信区间为 0.43 至 0.64)。大多数研究的证据质量中等,异质性明显:结论:新辅助内分泌治疗与乳房切除率的降低有关。结论:新辅助内分泌治疗与降低乳腺切除率有关。鉴于以往研究的方法学质量一般,需要进一步开展 RCT 研究:CRD42020209257。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信