Risk factors for joint symptoms in postmenopausal Japanese breast cancer patients treated with anastrozole: a prospective multicenter cohort study of patient-reported outcomes
Risk factors for joint symptoms in postmenopausal Japanese breast cancer patients treated with anastrozole: a prospective multicenter cohort study of patient-reported outcomes
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DOI：
10.1007/s10147-015-0905-5
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发表时间：
2016-04-01
影响因子：
3.3
通讯作者：
Miyoshi, Yasuo
中科院分区：
文献类型：
--
作者：
Egawa, Chiyomi;Hirokaga, Kouichi;Miyoshi, Yasuo
内分泌治疗相关不良事件对患者的生活质量有很大影响，有时会导致治疗中止。由于关节症状是芳香化酶抑制剂最常见的副作用，因此对相关风险因素的评估可能会产生重要的发现。在这项前瞻性队列研究中，共有391名绝经后雌激素受体阳性乳腺癌并接受辅助阿那曲唑治疗的日本女性入选，以评估患者报告的结局（PRO）（SAVS-JP，UMIN 000002455）。患者在基线和治疗3、6、9和12个月后完成自我报告问卷，以评估治疗相关关节症状（关节痛、关节活动范围减少和关节僵硬）的频率。我们从362例患者（92.6%）中获得了基线和一个或多个后续时间点的PRO。260例患者（71.8%）报告了新发关节症状或较基线恶化。超过90%的症状为轻度或中度，近80%的症状在6个月内发生。多因素分析显示，绝经后时间短[比值比（OR）0. 95，95%可信区间（CI）0. 90 - 0. 99; P = 0. 02]和辅助化疗（OR 2. 29，95% CI 1. 06 - 4. 95; P = 0. 03）是关节症状的显著独立危险因素。体重指数（BMI）和关节症状之间没有显着关系。18例患者在第1年停止治疗，其中8例报告了关节症状，考虑到PRO可能比关键临床试验中发表的症状的医生评级产生更高的患病率，我们发现绝经后短时间跨度和使用辅助化疗，但不是高BMI，与关节症状显著相关。这些发现可能被证明是有用的咨询前开始治疗与辅助芳香化酶抑制剂在绝经后的日本妇女。
Endocrine treatment-related adverse events have a strong impact on patients' quality of life and sometimes result in treatment discontinuation. Since joint symptoms are the most frequently recognized side effect of aromatase inhibitors, evaluation of associated risk factors may yield significant findings.A total of 391 postmenopausal Japanese women with estrogen receptor-positive breast cancer and treated with adjuvant anastrozole were enrolled from 28 centers for assessment of patient-reported outcomes (PROs) in this prospective cohort study (SAVS-JP, UMIN000002455). Patients completed the self-report questionnaire at baseline and after 3, 6, 9, and 12 months of treatment for evaluation of frequency of treatment-related joint symptoms (arthralgia, decrease in range of joint motion, and joint stiffness).We obtained PROs from 362 patients (92.6 %) at baseline and at one or more subsequent points. New or worsening from baseline of joint symptoms were reported by 260 patients (71.8 %). More than 90 % of the symptoms were mild or moderate and nearly 80 % had occurred by 6 months. Multivariate analysis showed that a short time span after menopause [odds ratio (OR) 0.95, 95 % confidence interval (CI) 0.90-0.99; P = 0.02] and adjuvant chemotherapy (OR 2.29, 95 % CI 1.06-4.95; P = 0.03) were significant independent risk factors for joint symptoms. No significant relationships between body mass index (BMI) and joint symptoms were identified. Eighteen patients discontinued treatment during the 1st year and eight of them reported joint symptoms.Taking into consideration that PROs may yield higher prevalence rates than physician ratings for symptoms published in pivotal clinical trials, we found that a short time span after menopause and use of adjuvant chemotherapy, but not high BMI, were significantly associated with joint symptoms. These findings might prove useful for counseling before initiating treatment with adjuvant aromatase inhibitors in postmenopausal Japanese women.