第一临床医学院知识库

目的：用Meta分析系统评估乳腺癌术后放疗序贯或同步激素治疗的有效性和安全性。

方法：电子计算机检索外文数据库（PubMed数据库和Cochrane图书馆）及中文数据库（中国生物医学文献数据库(CBM)、万方数据库、维普数据库(VIP)、中国期刊全文数据库(CNKI)），搜集放疗联合激素治疗对于乳腺恶性肿瘤术后的治疗的相关研究，对纳入研究进行方法学的质量评价,并用Stata 12.0软件进行汇总分析，计算各个指标的相对危险度(RR) 和它的95%可信区间 (CI)。

结果：总共纳入14篇文献（4个随机对照研究、10个回顾性队列研究），包括2862例患者。研究结果显示：序贯组与同步组的≥5年总生存率 （相对危险度为1.00，95％可信区间为0．93～1．07, P=0．907）、≥2年无事件生存率 (相对危险度为1.00，95％可信区间为0．92～1．08, P=0．909)、复发 (相对危险度为1.07，95％可信区间为0．86～1．32, P=0．536)、远处转移(相对危险度为1.09，95％可信区间为0．89～1．34, P=0．401)、发生肺纤维化(相对危险度为0.88，95％可信区间为0．56～1．38, P=0．580)、肺炎(相对危险度为0.81，95％可信区间为0．41～1．61, P=0．543)，皮肤纤维化(相对危险度为0.93，95％可信区间为0．63～1．36, P=0．696)差异无统计学意义。基于研究类型、国家、激素治疗方案进行的亚组分析结果显示：序贯组和同步组中这些观察指标差异仍无统计学意义。

结论：放疗序贯或同步激素治疗对于乳腺癌术后患者的≥5年总生存率、≥2年的无事件生存率、复发、远处转移、发生肺纤维化、肺炎、皮肤纤维化风险无明显差异。然而，当前研究纳入的回顾性文章较多，未来需要一些随机、高质量、大样本、多中心的前瞻性研究对此结果进一步证实。

Objective：Using Meta-analysis to systematically evaluate the effectiveness and safety of radiotherapy sequential or synchronous endocrine therapy for breast cancer patients after operation

Methods: The relevant studies investigating radiotherapy sequential or synchronous endocrine therapy for breast cancer patients after operation by searching foreign language databases (PubMed and Cochrane Library) and Chinese databases (China National Knowledge Infrastructure, VIP Database, Chinese Biomedical Literature Data and Wanfang Database) were included, then the methodological quality of included studies were evaluated. Meta-analysis was performed using STATA 12.0 software and relative risk (RR) with its 95% confidence interval (CI) were estimated.

Results: A total of 14 literatures (4 randomized controlled trials and 10 retrospective cohort studies) involving 2862 breast cancer patients after operation were included．The results showed there is no statistically significant difference between sequential group and concurrent group in terms of ≥5-year overall survival（OS）rate [relative risk(RR)=1.00，95％ confidence interval(CI)：0．93～1．07, P=0．907], ≥2-year event-free survival (EFS)(RR =1.00，95％CI：0．92～1．08, P=0．909), recurrence(RR =1.07，95％CI：0．86～1．32, P=0．536), distant metastasis(RR =1.09，95％CI：0．89～1．34, P=0．401), pulmonary fibrosis(RR =0．88，95％CI：0．56～1．38, P=0．580), pneumonia(RR =0．81，95％CI：0．41～1．61, P=0．543), skin fibrosis(RR =0．93，95％CI：0．63～1．36, P=0．696).  The different significant correlation was also not existed between sequential group and concurrent group in the subgroups of research types, different countries and endocrine therapies.

Conclusions: For breast cancer patients after operation,≥5-year overall survival,≥2-year event-free survival, recurrence, distant metastasis, pulmonary fibrosis, pneumonia and skin fibrosis of sequential group and concurrent group had no significant differences．However, included clinical trials are almost retrospective,  randomized, high-quality, large sample, multi-center prospective studies are needed for further verification.