Systematic Review On Neoadjuvant Endocrine Therapy Of Breast Cancer

Abstract:Objective:Neoadjuvant hormonal therapy, with its good results has been token much attention at home and abroad. Ten years ago, China began to be used in clinical treatment. The published studies were systematic reviewed about the neoadjuvant therapy of breast cancer with appliance envidence-based idea, The difference of therapeutic and adverse effects was analysed to look for the best treatment and supply the proof of evidence-based medicine to choose the best treatment for postmenopausal breast cancer patients. Methods:By using electric and handcraft searches and literature review, collect all the Chinese and English studies which involved the neoadjuvant therapy of breast cancer to systematic review, evaluate them on methodology, distill the data and describe these data, then quantitatively analyze the eligible data and verify the results according the literature heterogeneity,make Meta-analyses or accumulative Meta-analysis by fixed effect model or random effect model, make sensitivity analysis for different results, evaluate bias by funnel plot, linear regression and fail-safe number. Results:1 Meta-analysis results about neoadjuvant therapy of breast cancer:(1)Compared with tamoxifen group, complete remission rate RD=0.07,95%CI[0.03,0.11]; partial remission rate RD=0.19,95%CI[0.10, 0.27]; total effective rate RD=0.23,95%CI [0.17,0.29]; rate of disease stability RD=-0.08,95%CI[-0.13,-0.02]; total benefit rate RD=0.15, 95%CI[0.10,0.20]; rate of disease progression RD=-0.09,95%CI [-0.14,-0.04]; breast conserving surgery rate RD=0.10,95%CI [0.03,0.16], these results have significant, but the rate of adverse incident RD=-0.04,95%CI [-0.10,0.02], no significant.(2)Related cumulated analysis showed that all results of Meta-analysis were statistically significant differences in sample size or published with the cumulative number of years, RD point estimated value and 95%CI tended to have preferable change direction.(3)Sensitivity analysis results were similar to the Meta analysis, linear regression showed that the level of the test=0.05 statistically significant funnel plot symmetrical about safety and less than 5k+10,publicationbias does not get better control. Conclusion:(1)Compared with tamoxifen, letrozole preoperative Treatment can improve the complete remission rate,partial response rate,total effective rate,total benefit rate,breast conserving surgery rate,breast conserving surgery rate.whereas, rate of disease stability and rate of disease progression are inferior to tamoxifen. (2)Response rate of adverse events in this study could not explain the advantages of letrozole compared with tamoxifen, but also need a large number of long-term clinical treatment and follow-up further to confirm. (3) The results of Meta-analysis related to chinese test showed that the rate of disease progression, letrozole can not explain that the rate of disease progression has more advantages.Maybe there are many reasons. Also need to multiple large samples of high-quality test and long-term follow-up.