Postdiagnosis social networks and breast cancer mortality in the After Breast Cancer Pooling Project.
Postdiagnosis social networks and breast cancer mortality in the After Breast Cancer Pooling Project.
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作者：
Kroenke CH;Michael YL;Poole EM;Kwan ML;Nechuta S;Leas E;Caan BJ;Pierce J;Shu XO;Zheng Y;Chen WY
大型社交网络与更好的总体生存率相关，但与乳腺癌（BC）特异性结果并不一致。我们在一个大型队列中评估了诊断后社交网络与BC预后的关系。9267名来自乳腺癌后汇集项目的女性提供了诊断后大约两年内的社交网络数据。社会网络指数来源于配偶/伴侣的存在、宗教关系、社区关系、友谊关系以及在世的一级亲属的数量等信息。我们使用Cox模型来评估相关性，并使用荟萃分析来确定效应估计是否因队列而异。我们根据人口统计学、社会、肿瘤和治疗因素进行分层。1448例复发，1521例死亡，990例来自BC。四个队列中有三个的关联相似。协变量调整后，与社会整合的女性相比，社会孤立的女性（小网络）有更高的复发风险（HR=1.43, 95% CI: 1.15-1.77）、bc特异性死亡率（HR=1.64, 95% CI: 1.33-2.03）和总死亡率（HR=1.69, 95% CI:1.43 - 1.99）；这种关联在I/II期癌症患者中更强。在第四个队列中，与bc特异性结局无显著关联。缺乏配偶/伴侣（p=0.02）和社区关系（p=0.04）预测老年白人女性的bc特异性死亡率更高，而其他女性则不然。然而，缺乏亲属关系（p=0.02）和友谊关系（p=0.01）仅在非白人女性中预测更高的bc特异性死亡率。在一个大的汇集队列中，更大的社会网络与更好的bc特异性和总体生存率相关。临床医生应该评估社会网络信息作为预后的一个标志，考虑到关键的支持可能因社会人口因素而异。在这项涉及9267名乳腺癌女性患者的大型、前瞻性、合并队列研究中，被社会隔离的女性有更高的复发风险、乳腺癌特异性死亡率和总体死亡率。在具体联系和结果的分析中，具体关联因年龄、种族/民族和原籍国而异，这表明关键支持因社会人口因素而异。
Large social networks have been associated with better overall survival though not consistently with breast cancer (BC)-specific outcomes. We evaluated associations of post-diagnosis social networks and BC outcomes in a large cohort. 9,267 women from the After Breast Cancer Pooling Project provided data on social networks within approximately two years following diagnosis. A social network index was derived from information about the presence of a spouse/partner, religious ties, community ties, friendship ties, and numbers of first-degree, living relatives. We used Cox models to evaluate associations, and meta-analysis to determine whether effect estimates differed by cohort. We stratified by demographic, social, tumor, and treatment factors. There were 1,448 recurrences and 1,521 deaths, 990 from BC. Associations were similar in three of four cohorts. After covariate adjustment, socially isolated women (small networks) had higher risks of recurrence (HR=1.43, 95% CI:1.15–1.77), BC-specific mortality (HR=1.64, 95% CI:1.33–2.03), and total mortality (HR=1.69, 95% CI:1.43–1.99), compared to socially integrated women; associations were stronger in those with stage I/II cancer. In the fourth cohort, there were no significant associations with BC-specific outcomes. A lack of a spouse/partner (p=0.02) and community ties (p=0.04) predicted higher BC-specific mortality in older, White, but not other, women. However, a lack of relatives (p=0.02) and friendship ties (p=0.01) predicted higher BC-specific mortality in non-White women only. In a large pooled cohort, larger social networks were associated with better BC-specific and overall survival. Clinicians should assess social networks information as a marker of prognosis considering that critical supports may differ by sociodemographic factors. In this large, prospective, pooled cohort study of 9,267 women with breast cancer, women who were socially isolated had higher risks of recurrence, breast cancer-specific mortality, and overall mortality. In analyses of specific ties and outcomes, specific associations differed by age, race/ethnicity, and country of origin suggesting that critical supports differ by sociodemographic factors.