The effects of adjuvant endocrine therapy on long-term outcomes from ductal carcinoma in situ: a systematic review and meta-analysis

IF 5.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Breast Pub Date : 2025-06-18 DOI:10.1016/j.breast.2025.104521

Qian Chen , Ian Campbell , Mark Elwood , Alana Cavadino , Phyu Sin Aye , Sandar Tin Tin

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引用次数: 0

Abstract

Background

Although adjuvant endocrine therapy (ET) is a standard treatment for hormone receptor positive ductal carcinoma in situ (DCIS), its use is variably recommended by clinicians. This paper reviewed the effects of ET in relation to recurrence and survival across diverse populations.

Methods

PubMed, Embase, Web of Science, and Cochrane were searched for studies that reported outcomes of DCIS treated with ET versus no ET.

Results

Three randomised trials and 42 cohort studies were included. In the trials, tamoxifen significantly reduced the risk of in-breast recurrence with a pooled hazard ratio (HR) of 0.69 (95 % CI: 0.60, 0.80). In the cohort studies, ET was associated with lower risks of any recurrence (HR 0.67; 95 % CI: 0.55, 0.83), ipsilateral breast tumour recurrence (HR 0.59; 0.51, 0.69), loco-regional recurrence (HR 0.74; 0.53, 1.02) and contralateral breast cancer (HR 0.70; 0.49, 1.00), and improved overall survival (HR 0.85; 0.79, 0.90). No significant association between ET and breast cancer specific survival was observed in either trials or cohort studies. Subgroup analyses within the cohort studies showed no significant differences in the pooled HRs for recurrence and survival by follow-up length, confounding adjustment or treatment type.

Conclusions

The use of adjuvant ET reduces the risk of recurrence in patients with DCIS in clinical trials, as well as in the real-world setting. Survival benefits, however, warrant further study.

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辅助内分泌治疗对导管原位癌长期预后的影响：一项系统回顾和荟萃分析

虽然辅助内分泌治疗（ET）是激素受体阳性导管原位癌（DCIS）的标准治疗方法，但临床医生对其使用的建议各不相同。本文综述了ET在不同人群中与复发和生存相关的影响。方法检索spubmed、Embase、Web of Science和Cochrane，检索报道ET治疗DCIS与未治疗DCIS结果的研究。结果纳入3项随机试验和42项队列研究。在试验中，他莫昔芬显著降低了乳房内复发的风险，合并风险比（HR）为0.69 （95% CI: 0.60, 0.80）。在队列研究中，ET与较低的复发风险相关(HR 0.67；95% CI: 0.55, 0.83)，同侧乳腺肿瘤复发(HR 0.59；0.51, 0.69)，局部区域复发(HR 0.74；0.53, 1.02)和对侧乳腺癌(HR 0.70；0.49, 1.00)，总生存期提高(HR 0.85；0.79, 0.90)。在试验或队列研究中均未观察到ET与乳腺癌特异性生存率之间的显著关联。队列研究中的亚组分析显示，随访时间、混杂调整或治疗类型对复发和生存的总hr没有显著差异。结论：在临床试验和现实环境中，辅助ET的使用降低了DCIS患者复发的风险。然而，生存效益值得进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Breast 医学-妇产科学

CiteScore

8.70

自引率

2.60%

发文量

165

审稿时长

59 days

期刊介绍： The Breast is an international, multidisciplinary journal for researchers and clinicians, which focuses on translational and clinical research for the advancement of breast cancer prevention, diagnosis and treatment of all stages.