The Association Of Endocrine Interventions With Breast Cancer In Women:A Meta-analysis

Objective:This study aims to explore the preventive effect of endocrine therapy(ET)on special female population and the difference in safety of different endocrine therapy drugs through Bayesian network meta-analysis.Method:To begin with,the inclusion and exclusion criteria of subjects were established.According to the PICOS principle,from the establishment of Pub Med,Embase,Cochrane Library to September 15,2020,a systematic and comprehensive search was conducted on the randomized controlled trials of endocrine therapy drugs for the prevention about breast diseases.The number of specific events and sample size were extracted from each of the included studies.This Bayesian theory-based network meta-analysis included the indirect comparisons and the mixed treatment analysis.Findings:A total of 9 randomized controlled trials(RCTs)involving 60,732 participants were included.As a result,compared with placebo in high-risk pro-or post-menopausal women,endocrine therapy(ET)decreased the risks of total breast cancer(TBC,odds ratio OR 0.69,95%confidence interval CI 0.56-0.85),invasive breast cancer(IBC,OR 0.69,95%CI 0.53-0.89),estrogen receptor-positive breast cancer(ER~+BC,OR 0.49,95%CI 0.38-0.64)and ductal carcinoma in situ(DCIS,OR 0.74,95%CI 0.56-0.98),but increased the risks of pulmonary embolism(PE,OR 1.33,95%CI 1.05-1.69),total venous thrombosis(VT,OR 1.75,95%CI1.28–2.38)and endometrial carcinoma(EC,OR 1.84,95%CI 1.17–2.88).In further network stratification analyses,anastrozole,exemestane and tamoxifen were found to decrease the risks of TBC,IBC and ER+BC relative to placebo.Similarly,raloxifene decreased the risk of IBC(OR 0.65,95%CI 0.48-0.85),while tamoxifen increased the risk of EC(OR 2.42,95%CI 1.10-7.35).Conclusions:To sum up,ET decreased the risks of TBC,IBC,ER+BC and DCIS,while increasing the risks of PE,total VT and EC in high-risk pro-or postmenopausal women.Meanwhile,anastrozole,exemestane and tamoxifen possibly exerted potential protective effects on TBC,IBC ER+BC.Typically,raloxifene might be effective on IBC,while tamoxifen might increase the risk of EC.Therefore,clinicians should fully weigh the benefits and risks of ET to develop a rational individualized treatment.