本文選題：乳腺癌　切入點(diǎn)：芳香化酶抑制劑　出處：《河南科技大學(xué)》2017年碩士論文

【摘要】：目的:探究絕經(jīng)后激素受體陽(yáng)性的乳腺癌患者序貫應(yīng)用他莫昔芬與第3代芳香化酶抑制劑的療效和安全性是否優(yōu)于單獨(dú)應(yīng)用他莫昔芬或第3代芳香化酶抑制劑。方法:計(jì)算機(jī)檢索Cochrane、Pub Med、Embase、中國(guó)知網(wǎng)、萬(wàn)方等數(shù)據(jù)庫(kù),納入關(guān)于他莫昔芬與芳香化酶抑制劑序貫治療方案對(duì)比單藥治療方案治療絕經(jīng)后激素受體陽(yáng)性乳腺癌的隨機(jī)對(duì)照研究,并逐篇行質(zhì)量評(píng)價(jià),提取資料,應(yīng)用風(fēng)險(xiǎn)比及優(yōu)勢(shì)比評(píng)估對(duì)比結(jié)果,并采用RevMan5.3軟件進(jìn)行數(shù)據(jù)分析。結(jié)果:根據(jù)嚴(yán)格的納入排除標(biāo)準(zhǔn),共納入10篇文獻(xiàn),共22005例絕經(jīng)后激素受體陽(yáng)性乳腺癌患者。其中序貫治療方案對(duì)比他莫昔芬單藥治療方案共7篇,共7592例患者;序貫治療方案對(duì)比芳香化酶抑制劑單藥治療方案共3篇,共14413例患者。對(duì)于生存期的統(tǒng)計(jì)分析顯示序貫方案對(duì)比他莫昔芬單藥方案可明顯延長(zhǎng)患者總生存期HR=0.71(95%CI 0.52-0.98,P=0.04),和無(wú)復(fù)發(fā)生存期HR=0.60(95%CI 0.46-0.79,P=0.0003),且降低了死亡事件發(fā)生率OR=0.70(95%CI 0.59-0.83,P0.0001),遠(yuǎn)處轉(zhuǎn)移事件發(fā)生率OR=0.76(95%CI 0.62-0.92,P=0.006)。但序貫方案對(duì)比芳香化酶抑制劑單藥方案并沒(méi)有顯著改善患者生存獲益,總生存期HR=1.01(95%CI 0.93-1.11,P=0.79),無(wú)病生存期HR=1.01(95%CI 0.93-1.09,P=0.89)。在不良事件中序貫治療方案對(duì)比他莫昔芬單藥方案降低了子宮內(nèi)膜增生事件發(fā)生率OR=0.23(95%CI 0.11-0.46,P0.0001),子宮內(nèi)膜癌事件的發(fā)生率OR=0.18(95%CI 0.04-0.82,P=0.03);且沒(méi)有增加局部復(fù)發(fā)事件發(fā)生率OR=0.81(95%CI 0.62-1.05,P=0.11),生殖器官出血事件發(fā)生率OR=0.87(95%CI 0.63-1.20,P=0.40),心臟病事件發(fā)生率OR=0.91(95%CI 0.54-1.51,P=0.70),血栓/栓塞事件發(fā)生率OR=0.61(95%CI0.27-1.38,P=0.24),發(fā)熱事件發(fā)生率OR=0.94(95%CI 0.77-1.15,P=0.55);但增加了骨折事件發(fā)生率OR=1.30(95%CI 1.13-1.51,P=0.0004)。序貫治療方案對(duì)比第3代芳香化酶抑制劑單藥方案可降低骨折、心臟病事件的發(fā)生率;對(duì)子宮內(nèi)膜癌、死亡、局部復(fù)發(fā)事件發(fā)生率的影響無(wú)明顯差別;但升高了子宮內(nèi)膜增生、生殖器官出血、血栓/栓塞、遠(yuǎn)處轉(zhuǎn)移、發(fā)熱等事件的發(fā)生率。結(jié)論:序貫方案對(duì)比他莫西芬單藥方案,有較好療效及安全性;對(duì)比芳香化酶抑制劑單藥方案,在生存獲益上并無(wú)優(yōu)勢(shì)。
[Abstract]:Aim: to investigate the efficacy and safety of sequential tamoxifen and aromatase inhibitors in postmenopausal patients with steroid-receptor positive breast cancer compared with tamoxifen or aromatase inhibitors alone.Methods: the databases of Cochraneus Pub Medbase, China Zhiwang and Wanfang were searched by computer, and were included in a randomized controlled study on the treatment of postmenopausal hormone receptor positive breast cancer by tamoxifen and aromatase inhibitor sequential therapy.The data were extracted, the risk ratio and the advantage ratio were evaluated and compared, and the data were analyzed by RevMan5.3 software.Results: according to the strict exclusion criteria, a total of 22005 postmenopausal hormone receptor positive breast cancer patients were included in 10 articles.Among them, there were 7 sequential regimens compared with tamoxifen monotherapy (7592 cases), and 3 sequential regimens compared with aromatase inhibitors (14413 cases).瀵逛簬鐢熷瓨鏈熺殑緇熻鍒嗘瀽鏄劇ず搴忚瘡鏂規(guī)瀵規(guī)瘮浠栬帿鏄旇姮鍗曡嵂鏂規(guī)鍙槑鏄懼歡闀挎?zhèn)ｈ�呮，

本文編號(hào)：1709596