Meta_Analysis在肿瘤循证医学中的应用_英文(3)

Chin J Clin Oncol (2008) 5: 1~9

risk for breast cancer with green tea consumption, highest versus non/lowest intake (OR=0.78, 95% CI=0.61~0.98). Postmenopausal hormone therapy is widely used in developed countries and has become acceptable in China[10]. Shah et al.[10] reported results of a meta-anal-ysis of 13 studies including 700,000 patients. Post-menopausal estrogen therapy showed an increased OR of 1.16 (95% CI=1.06~1.28), with estimates for less than 5 years use, 1.16 (95% CI=1.02~1.32) and more than 5 years use, 1.20 (95% CI=1.06~1.37). Postmenopausal combined (estrogen-progestogen) hormone therapy resulted in an OR of 1.39 (95% CI=1.12~1.72), with estimates for less than 5 years use of 1.35 (95% CI=1.16, 1.57) and more than 5 years use, 1.63 (95% CI=1.22, 2.18). Megdal et al.[11] summarized that night work showed an increased breast cancer risk among women (RR, 1.51; 95% CI=1.36~1.68).

ScreeningHay et al.[12] conducted a meta-analysis of 12 prospec-tive studies that measured concern about breast can-cer at a baseline and subsequent breast self-examina-tion (BSE) or mammography utilization among 3,342 high-risk and general-population women. The meta-analysis supports the contention that breast cancer concern may motivate screening behavior, and that high levels of breast cancer concern are uncommon. Its finding is very important for behavior intervention research as well as to conduct breast cancer screen-ing. Benefits of screening mammography used for breast cancer have been analyzed by Hendrick, et al.[13] Meta-analysis including the most recent follow-up data from eight RCTs involving women aged 40~49 at entry demonstrates for the first time a sta-tistically significant 18% mortality reduction due to regular screening mammography in women of this age group. Unlike screening with mammography, breast self-examination (BSE) for early detection of breast cancer has produced significant results. Hackshaw and Paul[14] presented a meta-analysis of the effect of regular BSE on breast cancer mortality. There was no difference in the death rate in studies on women who detected their cancer during an examination (pooled RR 0.90, 95% CI=0.72~1.12). None of the trials of BSE training showed lower mortality, but showed more women seeking medical advice and having bi-opsies.

Therapyexpression and breast cancer has been widely investi-gated. De Laurentiis, et al.[15] reported a meta-analy-sis on the interaction between HER-2 expression and response to endocrine treatment in advanced breast cancer. The authors concluded that HER-2-positive metastatic breast cancer is less responsive to any type of endocrine treatment. This effect holds in the sub-group of patients with positive or unknown steroid receptors. Earlier detection of a breast cancer recurrence and metastases is important for patients with breast can-cer. Isasi, et al.[16] summarized the diagnostic perfor-mance of 18F-2-deoxy-2-fluoro-D-glucose-positron emission tomography (FDG-PET) in the evaluation of breast cancer recurrence and metastases. The pooled sensitivity was 90% (95% CI=86.8~93.2), and the pooled false positive rate was 11% (95% CI =7.8~14.6), after the exclusion of outliers. The maxi-mum combined sensitivity and specificity, was 88% (95% CI=86.0~90.6). FDG-PET is a valuable tool for detecting breast cancer recurrence and metastases. Mauri et al.[17] reported results of a meta-analysis and concluded that patients with breast cancer treated preoperatively with systemic therapy was apparently equivalent to those treated postoperatively with the same regimen in terms of survival and overall disease progression. Whelan et al.[18] conducted a meta-analysis includ-ing 18 trials (6,367 patients). Locoregional radiation after surgery in patients treated with systemic therapy was shown to reduce the risk of any recurrence (OR, 0.69; 95% CI=0.58~0.83), local recurrence (OR, 0.25; 95% CI=0.19~0.34), and mortality (OR, 0.83; 95% CI= 0.74~0.94). Evidence-Based Oncology for Lung CancerEtiologyHuman epidermal growth factor receptor-2 (HER-2) Except cigarette smoking, some other risk factors were analyzed recently by using meta-analysis. Based on 12 studies during 1990~2006, which de-tailed the relationship between lung cancer and the type of exposure, Mahjub and Sadri[19] reported that the OR of asbestos, cooking fuel, cooking fumes, motor and diesel exhaust related to lung cancer were 1.67, 1.99, 2.52 and 1.42 (P<0.001), respectively. The OR of metal fumes related to lung cancer was 1.28 (P<0.01). The combined OR for the environmental and occupational exposure related to lung cancer was 1.67 (P<0.001). Residential radon exposure is of serious public concern due to the fact that people stay in their rooms most of the time. Darby et al.[20] concluded that resi-

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