The Influence of Adjuvant Systemic Regimens on Contralateral Breast Cancer Risk and Receptor Subtype
The Influence of Adjuvant Systemic Regimens on Contralateral Breast Cancer Risk and Receptor Subtype
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DOI：
10.1093/jnci/djz010
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发表时间：
2019-07-01
影响因子：
10.3
通讯作者：
Schmidt，Marjanka K.
中科院分区：
文献类型：
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作者：
Kramer，Iris;Schaapveld，Michael;Schmidt，Marjanka K.
背景越来越多的乳腺癌（BC）幸存者有发生对侧乳腺癌（CBC）的风险。我们的目的是调查各种辅助系统方案的影响，亚型特异性，风险CBC.MethodsThis人群为基础的队列研究包括女性患者诊断为第一次侵入性BC之间2003年和2010年，随访完成，直到2016年。临床病理学数据来自荷兰癌症登记处，通过与PALGA联系获得受体状态的其他数据：荷兰病理学登记处。累积发病率（死亡和远处转移的竞争风险）和风险比（HR）估计所有侵入性异时CBC和CBC subtypes.ResultsOf 83 144 BC患者，2816开发CBC的10年累积发病率为3.8%（95%置信区间[CI] = 3.7%至4.0%）。总体而言，辅助化疗（HR = 0.70，95% CI = 0.62 - 0.80）、内分泌治疗（HR = 0.46，95% CI = 0.41 - 0.52）和曲妥珠单抗联合化疗（HR = 0.57，95% CI = 0.45 - 0.73）与CBC风险降低密切相关。具体而言，含紫杉烷的化疗（HR = 0.48，95% CI = 0.36至0.62）和芳香酶抑制剂（HR = 0.32，95% CI = 0.23至0.44）与CBC风险大幅降低相关。更详细的分析显示，与无内分泌治疗相比，内分泌治疗可显著降低雌激素受体（ER）阳性CBC（HR = 0.41，95% CI = 0.36 - 0.47）的风险，但不能显著降低ER阴性CBC（HR = 1.32，95% CI = 0.90 - 1.93）的风险。接受化疗的ER阴性的第一个BC的患者有较高的风险ER阴性CBC从5年的随访（HR = 2.84，95%CI = 1.62至4.99）与未接受化疗的ER阴性的第一个BC.ConclusionEndocrine治疗，化疗，以及曲妥珠单抗化疗降低CBC的风险。然而，每种辅助治疗方案对CBC亚型分布有不同的影响。含紫杉烷的化疗和芳香化酶抑制剂与CBC风险降低最大相关。
BackgroundAn increasing number of breast cancer (BC) survivors are at risk of developing contralateral breast cancer (CBC). We aimed to investigate the influence of various adjuvant systemic regimens on, subtype-specific, risk of CBC.MethodsThis population-based cohort study included female patients diagnosed with first invasive BC between 2003 and 2010; follow-up was complete until 2016. Clinico-pathological data were obtained from the Netherlands Cancer Registry and additional data on receptor status through linkage with PALGA: the Dutch Pathology Registry. Cumulative incidences (death and distant metastases as competing risk) and hazard ratios (HRs) were estimated for all invasive metachronous CBC and CBC subtypes.ResultsOf 83 144 BC patients, 2816 developed a CBC; the 10-year cumulative incidence was 3.8% (95% confidence interval [CI] = 3.7% to 4.0%). Overall, adjuvant chemotherapy (HR = 0.70, 95% CI = 0.62 to 0.80), endocrine therapy (HR = 0.46, 95% CI = 0.41 to 0.52), and trastuzumab with chemotherapy (HR = 0.57, 95% CI = 0.45 to 0.73) were strongly associated with a reduced CBC risk. Specifically, taxane-containing chemotherapy (HR = 0.48, 95% CI = 0.36 to 0.62) and aromatase inhibitors (HR = 0.32, 95% CI = 0.23 to 0.44) were associated with a large CBC risk reduction. More detailed analyses showed that endocrine therapy statistically significantly decreased the risk of estrogen receptor (ER)-positive CBC (HR = 0.41, 95% CI = 0.36 to 0.47) but not ER-negative CBC (HR = 1.32, 95% CI = 0.90 to 1.93) compared with no endocrine therapy. Patients receiving chemotherapy for ER-negative first BC had a higher risk of ER-negative CBC from 5 years of follow-up (HR = 2.84, 95% CI = 1.62 to 4.99) compared with patients not receiving chemotherapy for ER-negative first BC.ConclusionEndocrine therapy, chemotherapy, as well as trastuzumab with chemotherapy reduce CBC risk. However, each adjuvant therapy regimen had a different impact on the CBC subtype distribution. Taxane-containing chemotherapy and aromatase inhibitors were associated with the largest CBC risk reduction.