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. 2022 Oct 27:12:1039320.
doi: 10.3389/fonc.2022.1039320. eCollection 2022.

Extended adjuvant endocrine therapy for women with hormone receptor-positive early breast cancer: A meta-analysis with trial sequential analysis of randomized controlled trials

Ming Xie  1 , Yan Zhong  2 , Yide Yang  3 , Fang Shen  1 , Yue Nie  1   4
Affiliations

Extended adjuvant endocrine therapy for women with hormone receptor-positive early breast cancer: A meta-analysis with trial sequential analysis of randomized controlled trials

Ming Xie et al. Front Oncol. .

Abstract

Objectives: The aim of the current study is to explore the association between extended adjuvant endocrine treatment and prognosis of women with hormone receptor-positive (HR+) early breast cancer.

Methods: Databases including PubMed, Web of Science, Embase and the Cochrane Library databases were electronically searched to identify randomized controlled trials (RCTs) that reported extended endocrine therapy for women with HR+ early breast cancer. The retrieval time was limited from inception to September 2022. Two reviewers independently screened literature, extracted data, and assessed risk bias of included studies. Meta-analysis was performed by using R software Version 4.1.2 and STATA Version 12.0.

Results: A total of 15 RCTs involving 29497 cases were included. The overall analysis showed that compared with the control, extended adjuvant endocrine therapy increased disease-free survival (DFS) (HR=0.814, 95% CI: 0.720-0.922, 95% PI: 0.556-1.194), overall survival (OS) (HR=0.885, 95% CI: 0.822-0.953, 95% PI: 0.771-1.035), relapse-free survival (RFS) (HR=0.833, 95% CI: 0.747-0.927, 95% PI: 0.575-1.159), distant metastatic-free survival (DMFS) (HR=0.824, 95% CI: 0.694-0.979, 95% PI: 0.300-2.089) and reduced new breast cancer cumulative incidence (NBCCI) (HR=0.484, 95% CI: 0.403-0.583, 95% PI: 0.359-0.654). For adverse events, extended adjuvant endocrine treatment was associated with a significantly higher risk of bone fracture (RR=1.446, 95% CI: 1.208-1.730, 95% PI: 1.154-1.854) and osteoporosis (RR=1.377, 95% CI: 1.018-1.862, 95% PI: 0.347-5.456).

Conclusion: Our study showed that extended adjuvant endocrine therapy increased DFS, OS, RFS, DMFS, the incidence of bone fracture and osteoporosis, and reduced NBCCI.

Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier (CRD42022351295).

Keywords: aromatase inhibitor; disease-free survival; extended adjuvant endocrine therapy; overall survival; prognosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the process of selection of articles.
Figure 2
Figure 2
Forest plot of meta-analysis of extended adjuvant endocrine therapy for (A) disease-free survival, (B) overall survival, (C) relapse-free survival, (D) distant metastatic-free survival, and (E) new breast cancer cumulative incidence.
Figure 3
Figure 3
Forest plot of subgroup analysis of extended adjuvant endocrine therapy for disease-free survival (DFS). (A) Subgrouped by the extended treatment method in experimental and control arm; (B) subgrouped by the duration of adjuvant endocrine therapy; (C) subgrouped by menopausal state of patients; (D) subgrouped by lymph node positive/negative; (E) subgrouped by the type of prior endocrine treatment.
Figure 4
Figure 4
Forest plot of subgroup analysis of extended adjuvant endocrine therapy for overall survival (OS). (A) Subgrouped by the extended treatment method in experimental and control arm; (B) subgrouped by the duration of adjuvant endocrine therapy; (C) subgrouped by menopausal state of patients; (D) subgrouped by lymph node positive/negative; (E) subgrouped by the type of prior endocrine treatment.
Figure 5
Figure 5
Forest plot of meta-analysis of extended adjuvant endocrine therapy for adverse events. (A) Hot flashes, (B) bone fracture, (C) osteoporosis, (D) arthralgia.
See this image and copyright information in PMC

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