Evidence map›Paper›PMID 36898259›Full record

SynthesisBreast (Edinburgh, Scotland)2023

Tailoring the optimal duration of the extended adjuvant endocrine therapy in patients with early-stage breast cancer. A systematic review and meta-analysis of randomized clinical trials.

Laura Pala, Tommaso De Pas, Eleonora Pagan, Isabella Sala, Chiara Catania, Emma Zattarin, Paolo Arnone, Massimo M Grassi, Marco Colleoni, Antonio C Wolff and 6 more

Abstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in Breast (Edinburgh, Scotland), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Therapy of early breast cancer: current status and perspectives.Archives of gynecology and obstetrics · 2025
    Review
  3. Review
  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Laura PalaDepartment of Medical Oncology, Cliniche Humanitas Gavazzeni, Bergamo, 24125, Italy.
Tommaso De PasDepartment of Medical Oncology, Cliniche Humanitas Gavazzeni, Bergamo, 24125, Italy.
Eleonora PaganDepartment of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy.
Isabella SalaDepartment of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy.
Chiara CataniaDepartment of Medical Oncology, Cliniche Humanitas Gavazzeni, Bergamo, 24125, Italy.
Emma ZattarinDepartment of Medical Oncology, Cliniche Humanitas Gavazzeni, Bergamo, 24125, Italy.
Paolo ArnoneBreast Unit, Humanitas Gavazzeni Clinical Institute, Bergamo, Italy.
Massimo M GrassiBreast Unit, Humanitas Gavazzeni Clinical Institute, Bergamo, Italy.
Marco ColleoniDivision of Medical Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
Antonio C WolffJohns Hopkins University, Baltimore, MD, USA.
Javier CortesInternational Breast Cancer Center, Pangaea Oncology, Quiron Group, Madrid and Barcelona, Spain; Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Medicine, Madrid, Spain.
Martine PiccartInstitut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
Richard D GelberDepartment of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Harvard T.H. Chan School of Public Health, And Frontier Science & Technology Research Foundation, Boston, USA.
Giuseppe VialeDepartment of Pathology, European Institute of Oncology & University of Milan, Milan, Italy; University of Milan, Milan, Italy.
Vincenzo BagnardiDepartment of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy.
Fabio ConfortiDepartment of Medical Oncology, Cliniche Humanitas Gavazzeni, Bergamo, 24125, Italy. Electronic address: fabio.conforti@gavazzeni.it.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundControversy exists regarding the optimal duration of the extended adjuvant endocrine treatment (ET) in patients with early-stage breast-cancer (eBC). We performed a systematic review and trial-level meta-analysis of all randomized clinical trials (RCTs) comparing a "limited-extended" adjuvant ET (defined as more than 5 but less than 7.5 years of treatment overall) versus a "full-extended" adjuvant ET (defined as more than 7.5 years of treatment overall) in eBC.

methodsTo be eligible, RCTs had to i) compare a "limited-extended" adjuvant ET versus a "full-extended" adjuvant ET in patients with eBC; and ii) report disease-free survival (DFS) hazard ratio (HR) according to the disease nodal-status [i.e., nodal-negative (N-ve) versus nodal-positive (N + ve)]. The primary endpoint was to assess the difference in efficacy of full-versus limited-extended ET, measured in terms of the difference in DFS log-HR, according to the disease nodal-status. Secondary endpoint was the difference in efficacy of full-versus limited-extended ET according to tumor size (i.e., pT1 vs pT2/3/4), histological grade (i.e., G1/G2 vs G3), patients' age (i.e., ≤60 vs > 60 years) and previous type of ET (i.e., aromatase inhibitors vs tamoxifen vs switch strategy).

resultsThree phase III RCTs fulfilled the inclusion criteria. A total of 6689 patients were included in the analysis, of which 3506 (53%) had N + ve disease. The full-extended ET provided no DFS-benefit as compared with the limited-extended ET in patients with N-ve disease (pooled DFS-HR = 1.04, 95%CI: 0.89 to 1.22; I

conclusionsPatients with eBC and N + ve disease can obtain a significant DFS-benefit from the full-extended as compared with the limited-extended adjuvant ET.

Indexed as

Breast NeoplasmsAromatase InhibitorsChemotherapy, AdjuvantDisease-Free SurvivalFemaleHumansMiddle AgedRandomized Controlled Trials as TopicTamoxifenAromatase InhibitorsTamoxifenDisease nodal statusEarly breast cancerExtended adjuvant endocrine therapymeta-analysis

Identifiers

PMID36898259
PMCPMC10020092

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.