摘要
目的系统评价局部晚期乳腺癌新辅助化学治疗(以下简称化疗)剂量密集方案对比常规方案的疗效与安全性。方法计算机检索PubMed、Embase、Web of Science、CNKI、WanFang Data和VIP数据库,搜集对比乳腺癌新辅助化疗剂量密集方案与常规方案的随机对照试验(randomized controlled trials,RCT),检索时限均为建库至2021年3月1日。由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后采用Stata15.0软件进行meta分析。结果共纳入13个RCT,包括3258例患者,其中1625例患者接受了剂量密集新辅助化疗(dose-dense neoadjuvant chemotherapy,ddNACT),1633例患者接受了常规新辅助化疗(conventional neoadjuvant chemotherapy,cNACT)。meta分析结果显示:与cNACT组相比,ddNACT组的病理完全缓解率(P<0.001)、客观缓解率(P<0.001)和无病生存率(P=0.037)提高,2组总生存期(P=0.098)比较差异无统计学意义;ddNACT组3~4级口腔黏膜炎(P=0.005)和3~4级神经毒性(P<0.001)发生率均高于cNACT组,ddNACT组3~4级粒细胞减少发生率低于cNACT组(P=0.025),2组在3~4级血小板减少(P=0.152)、3~4级贫血(P=0.123)、化疗完成率(P=0.161)和保乳率(P=0.186)方面比较其差异均无统计学意义;激素受体阴性(hormone receptor negative,HR–)患者新辅助化疗后更易获病理完全缓解(P<0.001)。结论当前证据显示,在局部晚期乳腺癌患者中使用以蒽环类/紫杉类药物为基础的ddNACT方案较cNACT方案能提高病理完全缓解率、客观缓解率和无病生存率,HR–较HR+亚组新辅助化疗后病理完全缓解率更高,预防性使用粒细胞集落刺激因子能显著降低粒细胞减少的发生率,且大多数患者对剂量密集治疗是耐受的,两种化疗方案具有相似的完成率。
Objective To systematically evaluate the efficacy and safety of dose-dense neoadjuvant chemotherapy(ddNACT)and conventional neoadjuvant chemotherapy(cNACT)for locally advanced breast cancer(LABC).Methods PubMed,Embase,Web of Science,CNKI,Wanfang Data,and VIP databases were searched for randomized controlled trials(RCT)comparing ddNACT regimen with cNACT regimen for breast cancer.The time limit for retrieval was from establishment to March 1st,2021.Two reviewers independently screened literatures,extracted data and assessed risk bias of included studies;then,meta-analysis was performed by using Stata 15.0 software.Results A total of 13 RCTs were included,including 3258 patients,of which 1625 patients received ddNACT and 1633 patients received cNACT.The results of meta-analysis showed that the ddNACT regimen could improve the pathological complete response rate(pCR,P<0.001),objective response rate(ORR,P<0.001),and disease free survival(DFS,P=0.037)as compared with the cNACT regimen,there was no significant difference in the overall survival(OS)between the two groups(P=0.098).The incidences of grade 3 or 4 oral stomatitis(P=0.005)and neurotoxicity(P<0.001)were higher and the incidence of grade 3 or 4 neutropenia was lower(P=0.025)in the patients with ddNACT regimen,there were no significant differences in grade 3 or 4 thrombocytopenia(P=0.152),grade 3 or 4 anemia(P=0.123),chemotherapy completion rate(P=0.161)and breast conservative surgery rate(P=0.186)between the two groups.Patients with hormone receptor(HR)negative(HR–)were more likely to get pCR after neoadjuvant chemotherapy(P<0.001).Conclusions Current evidence shows that the use of anthracycline/taxane-based ddNACT regimen in LABC patients can improve the pCR,ORR,and DFS as compared with cNACT regimen.The pCR after neoadjuvant chemotherapy in the patients with HR–is higher than that with HR+.Prophylactic use of granulocyte-colony stimulating factor could significantly reduce the incidence of neutropenia,and most patients are tolerant to ddNACT regimen,2 re
作者
邓建
聂贤丽
胡莺菡
高旭东
陈进
权毅
DENG Jian;NIE Xianli;HU Yinghan;GAO Xudong;CHEN Jin;QUAN Yi(Department of Breast Surgery,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2022年第4期490-497,共8页
Chinese Journal of Bases and Clinics In General Surgery
基金
四川省科技厅专项资金计划项目(项目编号:14JC0197-LH38)。