Tumor characteristics and prognosis in women with pregnancy-associated breast cancer
Tumor characteristics and prognosis in women with pregnancy-associated breast cancer
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DOI：
10.1002/ijc.31174
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发表时间：
2018-04-01
影响因子：
6.4
通讯作者：
Lambe, Mats
中科院分区：
文献类型：
--
作者：
Johansson, Anna L. V.;Andersson, Therese M-L.;Lambe, Mats
有证据表明，在妊娠期间或分娩后2年内诊断出妊娠相关乳腺癌（PABC）的女性预后不良。我们使用一个大的、基于人群的队列研究了PABC妇女的临床病理特征和生存率。在瑞典癌症登记和乳腺癌质量登记中确定了1992年至2009年期间诊断为浸润性乳腺癌的15-44岁女性队列。每个妇女的分娩日期从瑞典多代登记册中检索。比较了未生育妇女和妊娠期和分娩后10年内乳腺癌妇女的肿瘤分期（肿瘤大小、淋巴结状态、转移）、Elston分级和ER/PR/HER 2状态的标准化分布。使用考克斯回归估计患者全因死亡率的校正风险比。我们确定了1，661名患有乳腺癌的未经产妇女，778名患有PABC的妇女（97名在怀孕期间，270名在产后第一年，411名在产后第二年）和3，598名在产后2-10年。与未生育妇女相比，患有PABC的妇女，尤其是分娩后0-12个月诊断的妇女，具有更先进的T和N分期，以及更高比例的ER/PR阴性、HER 2阳性和三阴性肿瘤。在调整年龄、年份、教育和地区后，在分娩后5年内诊断的妇女中观察到风险比增加。在对肿瘤特征进行额外调整后，风险比减弱且不显著。在PABC妇女中观察到的较差预后似乎在很大程度上是由诊断时更不利的肿瘤特征解释的。
There is evidence of poor prognosis in women with pregnancy-associated breast cancer (PABC) diagnosed during pregnancy or within 2 years of delivery. Using a large, population-based cohort, we examined clinicopathologic features and survival in women with PABC. A cohort of women diagnosed with invasive breast cancer between 1992 and 2009 at ages 15-44 years was identified in the Swedish Cancer Register and the Breast Cancer Quality Registers. Dates of childbirths for each woman were retrieved from the Swedish Multi-Generation Register. Age-standardized distributions of tumor stage (tumor size, nodal status, metastasis), Elston grade and ER/PR/HER2 status were compared between nulliparous women and women with breast cancer during pregnancy and up to 10 years postdelivery. Adjusted hazard ratios for all-cause mortality rates among patients were estimated using Cox regression. We identified 1,661 nulliparous women with breast cancer, 778 women with PABC (97 during pregnancy, 270 within first and 411 within second year postdelivery) and 3,598 during 2-10 years postdelivery. Compared to nulliparous women, women with PABC, and especially women diagnosed 0-12 months after delivery, had more advanced T and N stage, and higher proportions of ER/PR negative, HER2 positive and triple-negative tumors. Increased hazard ratios were observed in women diagnosed within 5 years of delivery after adjustment for age, year, education and region. Following additional adjustment for tumor characteristics, the hazard ratios were attenuated and nonsignificant. The poorer prognosis observed in women with PABC appears to be largely explained by more adverse tumor characteristics at diagnosis.