Effects of ovarian ablation or suppression in premenopausal breast cancer: A meta-analysis of randomized controlled trials

Publication date: Available online 5 December 2016
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Pan Zhang, Chang-Zai Li, Gui-Mei Jiao, Jin-Ji Zhang, Hui-Ping Zhao, Feng Yan, Shi-Feng Jia, Bao-Shan Hu, Chun-Tao Wu
BackgroundThe effect of ovarian ablation or suppression (OAS) in premenopausal women with breast cancer is controversial. In this study, the overall survival (OS), disease-free survival (DFS) and adverse event of OAS versus no OAS were compared.MethodsA literature review of EMBASE, Web of Science, PUBMED, and Cochrane Library were conducted. The hazard ratio (HR) and 95% confidence interval (CI) for OS and DFS, as well as risk ratio (RR) and 95% CI for adverse events were evaluated. I-squared statistic (I²) represents heterogeneity. Review Manager 5.3 was used to analyze the data.ResultsTwenty-nine studies with a total of 21249 women were included. In premenopausal women aged 40 years or younger, there were significant differences in OS (HR 0.78, 95% CI: 0.66–0.94, P=0.008, I²=0%) and DFS (HR 0.84, 95% CI: 0.73–0.97, P=0.02, I²=0%) between OAS and no OAS. In advanced stage breast cancer, a significant difference was found in OS (HR 0.76, 95% CI: 0.60–0.96, P=0.02, I²=0%), but there was no significant difference in DFS (HR 0.82, 95% CI: 0.50–1.33, P=0.41), with significant heterogeneity (P=0.16, I²=50%). Patients treated with OAS had more chances to have hot flushes (RR 1.91, 95% CI: 1.62–2.26, p<0.01, I²=0%) and vaginal dryness (RR 1.19, 95% CI: 1.08–1.31, P=0.0003, I²=0%). No significant difference in depression (RR 1.28, 95% CI: 0.94–1.74, P=0.12, I²=0%).ConclusionsThe study shows that OAS plays a beneficial role in premenopausal women aged40 years or younger and advanced stage breast cancer. However, OAS is associated with increase in hot flushes and vaginal dryness. There is potential publication bias. Further randomized evidence is needed.



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