Effects of estrogen receptor expression and histopathology on annual hazard rates of death from breast cancer
Effects of estrogen receptor expression and histopathology on annual hazard rates of death from breast cancer
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DOI：
10.1007/s10549-006-9231-y
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发表时间：
2006-11-01
影响因子：
3.8
通讯作者：
Rosenberg, Philip S.
中科院分区：
文献类型：
--
作者：
Anderson, William F.;Chen, Bingshu E.;Rosenberg, Philip S.
乳腺癌的发病率因雌激素受体表达（ER）和组织病理学而异。我们假设最初诊断后乳腺癌的年死亡率（危险率）也可能因ER和组织病理学而异。方法：我们加入了美国国家癌症研究所的监测、流行病学和最终结果（SEER, 1992-2002）项目，根据ER（阳性和阴性）和组织病理学（导管、管状、小叶、髓样、炎症、乳头状和黏液型）估计危险率。我们使用样条函数对ER阴性和阳性病例的总体和组织病理学进行了无强参数假设的风险率建模。结果ER阴性和ER阳性病例的危险率明显不同，且不成比例。在17个月时，ER阴性危险率达到每年7.5%的峰值（95% CI，每年7.3-7.8%），然后下降，而ER阳性危险率缺乏早期的尖峰，相对稳定在每年1.5-2%。在7年时，ER阴性下降和ER阳性持续的危险率交叉；术后ER阴性患者预后较好。在ER阳性和阴性病例中，根据组织病理类型存在成比例和非成比例的危险，但两种基本的ER相关模式保持不变。结论根据ER和组织病理学的不同，危险率在定性和定量上存在差异。这些基于大规模人群的结果似乎与基因组研究一致，显示了两类乳腺癌根据ER表达具有不同的预后。
Background Breast cancer incidence rates vary according to estrogen receptor expression (ER) and histopathology. We hypothesized that annual mortality rates from breast cancer after initial diagnosis (hazard rates) might also vary by ER and histopathology.Methods We accessioned the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER, 1992-2002) program to estimate hazard rates according to ER (positive and negative) and histopathology (duct, tubular, lobular, medullary, inflammatory, papillary, and mucinous types). We used spline functions to model hazard rates free of strongly parametric assumptions for ER negative and positive cases overall and by histopathology.Results Hazard rates for ER negative and ER positive cases were distinct and non-proportional. At 17 months, ER negative hazard rates peaked at 7.5% per year (95% CI, 7.3-7.8% per year) then declined, whereas ER positive hazard rates lacked a sharp early peak and were comparatively constant at 1.5-2% per year. Falling ER negative and constant ER positive hazard rates crossed at 7 years; after which, prognosis was better for ER negative cases. Among ER positive and negative cases, there were proportional and non-proportional hazards according to histopathologic type, but the two basic ER-associated patterns were maintained.Conclusions Hazard rates differed quantitatively and qualitatively according to ER and histopathology. These large-scale population-based results seem consistent with genomic studies, demonstrating two main classes of breast cancers with distinct prognoses according to ER expression.