Estrogen replacement therapy and breast cancer survival in a large screening study
Estrogen replacement therapy and breast cancer survival in a large screening study
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DOI：
10.1093/jnci/91.3.264
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发表时间：
1999-02-03
期刊：
影响因子：
--
通讯作者：
Hoover, RN
中科院分区：
文献类型：
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作者：
Schairer, C;Gail, M;Hoover, RN
背景：在一些研究中，激素替代疗法与乳腺癌患者死亡率的降低有关。目前尚不清楚这种关联是否反映了激素的生物活性或激素使用者中肿瘤的早期检测。根据诊断时雌激素的使用情况，我们检查了腋窝淋巴结阴性和淋巴结阳性乳腺癌妇女的乳腺癌死亡率。方法：对1973年至1981年1月期间诊断为绝经后乳腺癌的2614例患者的生命状况进行测定。我们估计了调整后的危险率比（调整肿瘤大小、年龄、种族、quette[体重]指数和淋巴结阳性妇女的淋巴结数量）和自诊断以来未调整的乳腺癌累计死亡概率。在淋巴结阴性疾病患者中，诊断时使用与未使用相关的乳腺癌死亡率之比在诊断后144个月为0.5(95%可信区间[CI] = 0.3-0.8)，此后为2.2 （95% CI = 0.9-5.2）。过去服用者的死亡率没有统计学上的显著降低。随访结束时，非使用者、既往使用者和当前使用者的乳腺癌死亡率累积概率分别为0.14、0.14和0.09。在患有淋巴结阳性疾病的妇女中，在诊断后48个月，与目前和过去使用相关的比率均为0.5（目前使用者95% CI = 0.3-0.8；过去使用者95% CI = 0.3-0.9），此后分别为1.1 （95% CI = 0.7-1.7）和1.8 （95% CI = 1.2-2.7）。在非使用者、过去使用者和目前使用者中，乳腺癌死亡率的累积概率分别为0.32、0.39和0.27。结论：在诊断时使用替代雌激素的乳腺癌患者乳腺癌死亡率下降，随着诊断时间的推移，死亡率下降。
Background: Hormone replacement therapy has been associated in some studies with reductions in breast cancer mortality among women who develop this disease. It is unclear whether this association reflects the biologic activity of the hormones or the earlier detection of tumors among hormone users. We examined breast cancer mortality among women who were diagnosed with axillary lymph node-negative and node-positive breast cancer according to the currency of estrogen use at diagnosis. Methods: Vital status through June 1995 was determined for 2614 patients with postmenopausal breast cancer diagnosed during the period from 1973 to January 1981. We estimated adjusted hazard-rate ratios (adjusting for tumor size, age, race, Quetelet [body mass] index, and number of positive lymph nodes in women with nodepositive disease) and unadjusted cumulative probabilities of breast cancer death over time since diagnosis, Results: Among patients with nodenegative disease, rate ratios for breast cancer mortality associated with current use compared with nonuse at diagnosis were 0.5 (95% confidence interval [CI] = 0.3-0.8) until 144 months after diagnosis and 2.2 (95% CI = 0.9-5.2) thereafter. Mortality was not statistically significantly lower in past users. The cumulative probabilities of breast cancer mortality at the end of follow-up were 0.14, 0.14, and 0.09 in nonusers, past users, and current users, respectively. Among women with nodepositive disease, the rate ratios associated with current and past use were both 0.5 until 48 months after diagnosis (95% CI = 0.3-0.8 for current users; 95% CI = 0.3-0.9 for past users) and were 1.1 (95% CI = 0.7-1.7) and 1.8 (95% CI = 1.2-2.7), respectively, thereafter. The cumulative probabilities of breast cancer mortality were 0.32, 0.39, and 0.27 in nonusers, past users, and current users, respectively. Conclusions: Patients with breast cancer who were using replacement estrogens at the time of diagnosis experienced reductions in breast cancer mortality, which waned with the time since diagnosis.