Evidence map›Paper›PMID 39423044›Full record

SynthesisBJS open2024

Surgical outcomes of neoadjuvant endocrine treatment in early breast cancer: meta-analysis.

Beatrice Brett, Constantinos Savva, Bahar Mirshekar-Syahkal, Martyn Hill, Michael Douek, Ellen Copson, Ramsey Cutress

Abstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in BJS open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–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

2 citing papers in PubMed.

  1. Article
  2. 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

7 authors.

Beatrice BrettCancer Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton, UK.
Constantinos SavvaCancer Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton, UK.ORCID 0000-0003-0805-4719
Bahar Mirshekar-SyahkalCambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Martyn HillNuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK.
Michael DouekNuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK.
Ellen CopsonCancer Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton, UK.
Ramsey CutressCancer Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNeoadjuvant endocrine therapy presents an important downstaging option with lower toxicity than neoadjuvant chemotherapy in oestrogen receptor (ER)-positive early breast cancer. Meta-analysis of the effects of neoadjuvant endocrine therapy on surgical outcomes across randomized clinical trials (RCTs) and cohort studies has not previously been performed.

methodsA systematic review and meta-analysis was performed to evaluate the effect of neoadjuvant endocrine therapy on surgical outcomes (PROSPERO (international prospective register of systematic reviews, 2020)) compared with surgery followed by adjuvant endocrine therapy. PubMed and EMBASE were searched to identify RCT and cohort studies between 1946 and 27 March 2024. Two independent reviewers manually screened the identified records and extracted the data. Risk of bias was assessed using the Cochrane Collaboration tools and random-effects meta-analysis was done with ReviewManager.

resultsThe search identified 2390 articles eligible for screening. The review included 20 studies (12 cohort and 8 RCTs); 19 were included in the meta-analysis with a total of 6382 patients. Overall, neoadjuvant endocrine therapy was associated with a lower mastectomy rate compared with surgery first (risk ratio (RR) 0.53, 95% c.i. 0.44 to 0.64). Subgroup analysis showed similar improvement in the mastectomy rate in the neoadjuvant endocrine therapy group versus control group irrespective of study type (RCT: RR 0.58, 95% c.i. 0.50 to 0.66; cohorts: RR 0.48, 95% c.i. 0.33 to 0.70). There was no difference in the mastectomy rate by duration of neoadjuvant endocrine therapy (more than 4 months: RR 0.57, 95% c.i. 0.42 to 0.78; 4 months or less than 4 months: RR 0.52, 95% c.i. 0.43 to 0.64). Most of the studies were characterized by moderate-quality evidence with significant heterogeneity.

conclusionNeoadjuvant endocrine therapy is associated with a reduction in mastectomy rate. Given the moderate methodological quality of previous studies, further RCTs are required. REGISTRATION ID: CRD42020209257.

Indexed as

Antineoplastic Agents, HormonalBreast NeoplasmsMastectomyNeoadjuvant TherapyChemotherapy, AdjuvantFemaleHumansTreatment OutcomeAntineoplastic Agents, Hormonal

Identifiers

PMID39423044
PMCPMC11488384

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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.