Impact of Comorbidities and Age on Cause-Specific Mortality in Postmenopausal Patients with Breast Cancer
Impact of Comorbidities and Age on Cause-Specific Mortality in Postmenopausal Patients with Breast Cancer
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DOI：
10.1634/theoncologist.2018-0010
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发表时间：
2019-07-01
期刊：
影响因子：
5.8
通讯作者：
Liefers, Gerrit-Jan
中科院分区：
文献类型：
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作者：
Derks, Marloes G. M.;van de Velde, Cornelis J. N.;Liefers, Gerrit-Jan
背景研究的目的是研究合并症和年龄对乳腺癌死亡率的影响，同时考虑相互竞争的死亡原因。对象、材料和方法对2001至2006年间纳入三苯氧胺和依西美坦多国(团队)试验的荷尔蒙受体早期阳性绝经后乳腺癌的荷兰和比利时患者进行队列分析。这是一项随机对照试验，研究对象是那些已完成局部治疗的患者，他们被随机分成两组，一组接受依西美坦治疗5年，另一组接受他莫昔芬和依西美坦的序贯治疗，疗程为5年。患者按合并症的数量(无合并症、1-2例合并症和2例合并症)和年龄(=70岁)进行分类。主要结果是将其他死因死亡率视为竞争事件的乳腺癌死亡率；使用累积发病率竞争风险方法计算累积发病率，并考虑竞争死因的影响，使用Fine and Gray模型计算年龄和合并症对乳腺癌死亡原因特定发病率的影响。结果共纳入3159例患者，其中2203例(69.7%)确诊时年龄=70岁。在70例无合并症的患者中，乳腺癌死亡率的累积发生率高于有2例合并症的患者(22.2%，95%CI，17.5-26.9)。结论没有合并症的老年患者比年轻患者死于乳腺癌的风险更高，即使考虑到更高的竞争死亡率，而这一组患者的化疗使用率较低。这些发现强调了在乳腺癌的预后中考虑合并症、年龄和竞争死亡率的必要性，以便做出准确的决策。对于实践的影响，没有共病的老年患者死于乳腺癌的风险增加，尽管其他原因的死亡率更高。这项研究表明，包括年龄和合并症在内的乳腺癌死亡率和其他原因死亡率的评估对于老年患者的治疗决策是不可或缺的。未来乳腺癌预后的预测工具应该包括这些项目以及辅助化疗的毒性风险，以充分预测结果，优化老年早期乳腺癌患者的个性化治疗。
Background The aim was to study the impact of comorbidities and age on breast cancer mortality, taking into account competing causes of death. Subjects, Materials, and Methods Cohort analysis of Dutch and Belgian patients with postmenopausal, early hormone receptor-positive breast cancer included in the Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial between 2001 and 2006. This is a randomized controlled trial of patients who had completed local treatment with curative intent and were randomized to receive exemestane for 5 years, or sequential treatment of tamoxifen followed by exemestane for a duration of 5 years. Patients were categorized by number of comorbidities (no comorbidities, 1-2 comorbidities, and >2 comorbidities) and age (= 70 years). Main outcome was breast cancer mortality considering other-cause mortality as competing event; cumulative incidences were calculated using the Cumulative Incidence Competing Risk Methods, and the Fine and Gray model was used to calculate the effect of age and comorbidities for the cause-specific incidences of breast cancer death, taking into account the effect of competing causes of death. Results Overall, 3,159 patients were included, of which 2,203 (69.7%) were aged = 70 years at diagnosis. Cumulative incidence of breast cancer mortality was higher among patients >= 70 without comorbidities (22.2%, 95% CI, 17.5-26.9) compared with patients 2 comorbidities, p < .001). Conclusion Older patients without comorbidities have a higher risk of dying due to breast cancer than younger counterparts, even when taking into account higher competing mortality, while use of chemotherapy in this group was low. These findings underline the need to take into account comorbidities, age, and competing mortality in the prognosis of breast cancer for accurate decision making. Implications for Practice Older patients without comorbidity are at increased risk of dying from breast cancer, despite a higher other-cause mortality. This study shows that including age and comorbidity for the assessment of breast cancer mortality and other-cause mortality is indispensable for treatment decision making in older patients. Future prognostic tools for breast cancer prognosis should incorporate these items as well as risk of toxicity of adjuvant chemotherapy to adequately predict outcomes to optimize personalized treatment for older patients with early breast cancer.