Hazard of Breast Cancer-Specific Mortality among Women with Estrogen Receptor-Positive Breast Cancer after Five Years from Diagnosis: Implication for Extended Endocrine Therapy
Hazard of Breast Cancer-Specific Mortality among Women with Estrogen Receptor-Positive Breast Cancer after Five Years from Diagnosis: Implication for Extended Endocrine Therapy
复制标题
雌激素受体阳性乳腺癌女性诊断后五年后乳腺癌特异性死亡率的风险：延长内分泌治疗的意义。
DOI：
10.1210/jc.2012-2423
复制
发表时间：
2012-12-01
影响因子：
5.8
通讯作者：
Shao, Zhi-Ming
中科院分区：
文献类型：
--
作者：
Yu, Ke-Da;Wu, Jiong;Shao, Zhi-Ming
目的
尽管进行了5年的内分泌治疗，但超过一半的雌激素受体(ER)阳性乳腺癌患者在确诊后5-10年内仍会复发并死于乳腺癌。5-10年乳腺癌特异性死亡率(BCSM)高风险的ER阳性患者的亚群尚不确定。
方法
利用监测、流行病学和最终结果计划(1990-2003)，我们分析了111,993名乳腺癌患者的BCSM的相对风险比(HR)和绝对风险比(HR)以及累积的10年乳腺癌特异性生存率(BCS)，按ER、年龄和淋巴结(LN)分层，并调整了其他预后因素。
结果
在诊断后5-10年，ER阳性患者与ER阴性患者相比，BCSM的风险增加[HR，0.71；95%可信区间(CI)，0.66-0.76；ER阳性]。具体地说，年轻的ER阳性患者(40岁)，尽管处于LN状态，但其年风险率保持稳定，BCSM的风险更高(HR，0.43；95%CI，0.35-0.52；ER阳性为参考)，10年内BCS较差。在40-60岁的ER阳性患者中，没有明显的风险平台，只有LN阳性的患者BCSM的风险显著增加，10年内BCS较差。60-74岁的ER阳性老年患者有BCSM的危险，与ER阴性的患者相似，而LN阳性患者的10年BCS较差。
结论
我们的发现有助于确定诊断后5-10年BCSM风险较高的ER阳性亚群，并有助于选择5年后扩大内分泌治疗的临床试验的候选者，并指导个体化治疗。
PURPOSE
More than half of the patients with estrogen receptor (ER)-positive breast cancers will relapse and die from breast cancer at 5-10 yr after diagnosis despite 5-yr endocrine therapy. Subpopulations of ER-positive patients at high risk of breast cancer-specific mortality (BCSM) at 5-10 yr are undetermined.
METHODS
Using the Surveillance, Epidemiology, and End-Results program (1990-2003), we analyzed the relative hazard ratio (HR) and absolute HR of BCSM and the cumulative 10-yr breast cancer-specific survival (BCSS) in 111,993 breast cancer patients, stratified by ER, age, and lymph node (LN), and adjusted for other prognostic factors.
RESULTS
At 5-10 yr after diagnosis, ER-positive patients had increased risk of BCSM [HR, 0.71; 95% confidence interval (CI), 0.66-0.76; ER-positive as reference] compared with ER-negative patients. Specifically, younger ER-positive patients (<40 yr) had a constant plateau of annual hazard rate, a higher hazard of BCSM (HR, 0.43; 95% CI, 0.35-0.52; ER-positive as reference), and poor 10-yr BCSS, despite LN status. Among ER-positive patients aged 40-60 yr having no obvious plateau of hazard rate, only those with LN-positive disease had a significantly increased hazard of BCSM and poor 10-yr BCSS. Elderly ER-positive patients aged 60-74 yr had a hazard of BCSM, similar to that of ER-negative patients, and those with LN-positive disease had poor 10-yr BCSS.
CONCLUSION
Our findings help to define the ER-positive subpopulations at higher risk of BCSM at 5-10 yr after diagnosis and are useful in choosing candidates for clinical trials of extended endocrine therapy after 5-yr treatment and in guiding individualized treatment.