Short-term Outcomes Of Neoadjuvant Endocrine Therapy Versus Neoadjuvant Chemotherapy In Breast Cancer:A Systematic Review And Meta-analysis

Objective : We searched the literature comparing the efficacy between neoadjuvant endocrine therapy and neoadjuvant chemotherapy,and used meta-analysis to analyze the short-term outcomes of neoadjuvant endocrine therapy and neoadjuvant chemotherapy in breast cancer treatment.It is hoped to provide a reference for the choice of neoadjuvant treatment in clinical diagnosis and treatment.Methods : By searching cnki.net,Wanfang data,Vip database,China Journal Net full-text database and Cochrane Library,Pub Med,EMBASE,Web of Science and other databases,we retrieved literature that directly compared the efficacy of neoadjuvant endocrine therapy and neoadjuvant chemotherapy.Collect relevant literature and data,and evaluate the quality of included literature.For studies with less heterogeneity,Rev Man 5.3 was used as a data analysis tool for meta-analysis.The main evaluation indicators of this study include: tumor response rate(RR),clinical complete response rate(c CR),pathological complete response rate(p CR),and breast conservation rate(BCS).Results:13 Articles were included,including 9 English articles and 4 Chinese articles.There were 1,380 patients with breast cancer,of which 598(43.3%)were in the neoadjuvant endocrine group and 782(56.7%)were in the neoadjuvant chemotherapy group.Meta analysis results showed that in ER-positive patients,there were no statistical differences between the two treatments in tumor response rate(OR=0.79,95% CI[0.58,1.06],p=0.12),clinical complete response rate(OR=0.45,95% CI[0.15,1.39],p=0.16),pathological complete response rate(OR=0.56,95% CI[0.28,1.13],p=0.10),and breast conservation rate(OR=1.23,95% CI[0.83,1.82],p=0.29).In HER-2 negative patients,there is no statistical difference in clinical complete response rate(OR=0.38,95%CI[0.06,2.33],p=0.30)and pathological complete response rate(OR=0.56,95%CI[0.24,1.32],p=0.19).Conclusion:It can be concluded from this study that neoadjuvant endocrine therapy for ER-positive and HER-2 negative postmenopausal breast cancer patients can obtain similar effects as neoadjuvant chemotherapy,but has not shown advantages.ER positive and HER-2 negative does not mean that patients can benefit more from neoadjuvant endocrine therapy.