Avtor/Urednik		Davies, C; Godwin, J; Gray, R; Čufer, T
Naslov		Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials
Tip		članek
Vir		Lancet
Vol. in št.		Letnik 378, št. 9793
Leto izdaje		2011
Obseg		str. 771-84
Jezik		eng
Abstrakt		Background: As trials of 5 years of tamoxifen in early breast cancer mature, the relevance of hormone receptor measurements (and other patient characteristics) to long-term outcome can be assessed increasingly reliably. We report updated meta-analyses of the trials of 5 years of adjuvant tamoxifen. Methods: We undertook a collaborative meta-analysis of individual patient data from 20 trials (n=21,457) in early breast cancer of about 5 years of tamoxifen versus no adjuvant tamoxifen, with about 80% compliance. Recurrence and death rate ratios (RRs) were from log-rank analyses by allocated treatment. Findings: In oestrogen receptor (ER)-positive disease (n=10,645), allocation to about 5 years of tamoxifen substantially reduced recurrence rates throughout the first 10 years (RR 0-53 [SE 0-03] during years 0-4 and RR 0-68 [0-06] during years 5-9 [both 2p<0-00001]; but RR 0-97 [0-10] during years 10-14, suggesting no further gain or loss after year 10). Even in marginally ER-positive disease (10-19 fmol/mg cytosol protein) the recurrence reduction was substantial (RR 0-67 [0-08]). In ER-positive disease, the RR was approximately independent of progesterone receptor status (or level), age, nodal status, or use of chemotherapy. Breast cancer mortality was reduced by about a third throughout the first 15 years (RR 0-71 [0-05] during years 0-4, 0-66 [0-05] during years 5-9, and 0-68 [0-08] during years 10-14; p<0-0001 for extra mortality reduction during each separate time period). Overall non-breast-cancer mortality was little affected, despite small absolute increases in thromboembolic and uterine cancer mortality (both only in women older than 55 years), so all-cause mortality was substantially reduced. In ER-negative disease, tamoxifen had little or no effect on breast cancer recurrence or mortality. Interpretation: 5 years of adjuvant tamoxifen safely reduces 15-year risks of breast cancer recurrence and death. (Abstract truncated at 2000 character)
Deskriptorji		BREAST NEOPLASMS CHEMOTHERAPY, ADJUVANT TAMOXIFEN NEOPLASM RECURRENCE, LOCAL RISK FACTORS RECEPTORS, ESTROGEN SURVIVAL ANALYSIS META-ANALYSIS RANDOMIZED CONTROLLED TRIALS