Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: A population-based study
Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: A population-based study
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DOI：
10.1016/j.ejca.2004.12.025
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发表时间：
2005-03-01
影响因子：
8.4
通讯作者：
Coebergh, JWW
中科院分区：
文献类型：
--
作者：
Louwman, WJ;Janssen-Heijnen, MLG;Coebergh, JWW
除乳腺癌外，共存疾病的流行在人口老龄化中变得越来越重要。然而，临床意义尚不清楚。研究人员分析了荷兰南部1995年至2001年诊断的所有新乳腺癌患者（n = 8966）严重合并症的年龄特异性患病率与年龄、分期和治疗的关系。评估了年龄和合并症的独立预后影响（随访持续到2004年1月1日）。合并症的患病率从50岁以下患者的9%增加到80岁以上患者的56%。最常见的疾病是心血管疾病（7%）、糖尿病（7%）和既往癌症（6%）。在存在合并症的情况下，接受放疗的患者较少（5.1% vs 66%, P < 0.0001），接受保乳手术的患者也较少进行腋窝清扫（P < 0.0001）。无合并症患者的相对5年生存率（87%）显著高于既往癌症患者（77%）、糖尿病患者（78%）和2+共存疾病患者（59%）（P < 0.01）。无合并症患者的相对生存率随着年龄的增长而增加，70岁以上患者的相对生存率为93%。合并症对预后有负面影响，与年龄、疾病分期和治疗无关(一种共存疾病的风险比（HR) = 1.3, P = 0.0001；两种以上共存疾病的风险比(HR) = 1.4, P = 0.0001）。影响最大的是既往癌症（HR = 1.4, P = 0.003）、脑血管疾病（HR = 1.6, P < 0.004）和痴呆（HR = 2.3, P < 0.0001）。老年乳腺癌患者可分为无其他疾病预后较好的患者和至少有一种其他严重共存疾病且预后明显较差的患者。(c) 2005 Elsevier Ltd版权所有。
The prevalence of coexistent diseases in addition to breast cancer becomes increasingly important in an ageing population. However, the clinical implications are unclear. The age-specific prevalence of serious comorbidity among all new breast cancer patients diagnosed from 1995 to 2001 (n = 8966) in the South of the Netherlands was analysed in relation to age, stage and treatment. Independent prognostic effects of age and comorbidity were evaluated (follow-up was continued until I January 2004). The prevalence of comorbidity increased from 9% for those aged < 50 years to 56% for patients aged 80+ years. The most frequent conditions were cardiovascular disease (7%), diabetes mellitus (7%), and previous cancer (6%). In the presence of comorbidity, fewer patients received radiotherapy (5 1% vs. 66%, P < 0.0001) and fewer patients who underwent breast-conserving surgery also had axillary dissection (P < 0.0001). Relative 5-year survival rates for patients without comorbidity (87%) were significantly higher (P < 0.01) than those for patients with previous cancer (77%), diabetes mellitus (78%), and for patients with 2+ coexistent diseases (59%). Relative survival of patients without comorbidity increased with age to 93% for patients older than 70 years. Comorbidity negatively affected prognosis, independent of age, stage of disease, and treatment (Hazard Ratio (HR) = 1.3, P = 0.0001 for one coexistent disease and HR = 1.4, P = 0.0001 for 2+ coexistent diseases). The most important effects were found for previous cancer (HR = 1.4, P = 0.003), cerebrovascular disease (HR = 1.6, P < 0.004) or dementia (HR = 2.3, P < 0.0001). Elderly breast cancer patients can be divided in those without other diseases, who have a relatively good prognosis, and those who have at least one other serious coexistent disease and significantly poorer prognosis. (c) 2005 Elsevier Ltd. All rights reserved.