Bisphosphonate Use and Risk of Recurrence, Second Primary Breast Cancer, and Breast Cancer Mortality in a Population-Based Cohort of Breast Cancer Patients.
Bisphosphonate Use and Risk of Recurrence, Second Primary Breast Cancer, and Breast Cancer Mortality in a Population-Based Cohort of Breast Cancer Patients.
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DOI：
10.1158/1055-9965.epi-17-0556
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发表时间：
2018-03
期刊：
影响因子：
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通讯作者：
Malone KE
中科院分区：
文献类型：
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作者：
Korde LA;Doody DR;Hsu L;Porter PL;Malone KE
双膦酸类药物的使用与乳腺癌复发的研究产生了相互矛盾的结果。对大型辅助试验的分析表明，双膦酸盐只在绝经后妇女中降低复发风险。我们在一组早期浸润性乳腺癌妇女(n=1813；平均随访11.8年)的人群预后队列中评估了非癌症治疗相关双膦酸盐的使用对乳腺癌预后的影响。使用医疗记录、访谈和癌症登记数据，收集关于风险因素、癌症治疗、药物使用和结果的信息。统计分析采用COX比例风险回归模型。使用双膦酸盐与乳腺癌事件(局部区域/远处复发或第二原发乳腺癌)的风险显著降低相关(HR曾经使用=0.65，95%CI为0.47-0.90)。观察到绝经前/围绝经期和绝经后妇女、ER阴性和ER阳性乳腺癌以及早期和晚期复发的风险都降低了。双膦酸类药物的使用也与乳腺癌死亡率显著降低相关(HR 0.40，95%CI 0.23-0.69)。在患有早期乳腺癌的妇女中，双膦酸盐的使用与乳腺癌事件风险的降低和乳腺癌特异性生存率的提高有关。我们推测，双膦酸类药物对乳腺癌预后的益处可能主要存在于骨密度较低且与绝经状态无关的女性中。我们的发现表明，进一步考虑将骨密度状况作为双膦酸盐对乳腺癌预后的潜在益处的修饰物是有必要的。
Studies of bisphosphonate use and breast cancer recurrence have produced conflicting results. Analyses of large adjuvant trials suggest that bisphosphonates reduce recurrence risk only in postmenopausal women. We assessed the effect of non-cancer treatment related bisphosphonate use on breast cancer outcomes in a population-based prognostic cohort of women with early stage invasive breast cancer (n=1813; median follow-up 11.8 years). Using medical record, interview, and cancer registry data, information was assembled on risk factors, cancer treatment, medication use, and outcomes. Statistical analyses utilized Cox proportional hazards regression models. Bisphosphonate use was associated with a significantly decreased risk of a breast cancer event (locoregional/distant recurrence or second primary breast cancer) (HR ever use = 0.65, 95% CI 0.47–0.90). Reduced risks were observed in both pre/peri and postmenopausal women, in both ER-negative and ER-positive breast cancers, and for both earlier and later recurrences. Bisphosphonate use was also associated with a significantly decreased risk of breast cancer mortality (HR 0.40, 95% CI 0.23–0.69). Bisphosphonate use was associated with a reduction in risk of breast cancer events and improved breast cancer specific survival in women with early stage breast cancer. We hypothesize that the benefit of bisphosphonates on breast cancer outcomes may be present primarily in women with low bone density and regardless of menopausal status. Our findings suggest further consideration of bone density status as a modifier of bisphosphonate’s potential beneficial benefits on breast cancer outcomes is warranted.