The prognostic effect of estrogen receptor status differs for younger versus older breast cancer patients
The prognostic effect of estrogen receptor status differs for younger versus older breast cancer patients
复制标题
DOI：
10.1007/s10549-017-4333-2
复制
发表时间：
2017-09-01
影响因子：
3.8
通讯作者：
Narod, Steven A.
中科院分区：
文献类型：
--
作者：
Sopik, Victoria;Sun, Ping;Narod, Steven A.
目的根据初诊年龄评估雌激素受体(ER)状态对女性浸润性乳腺癌患者预后的影响。方法我们研究了1987-2000年间在女子学院医院接受治疗的1910例女性浸润性乳腺癌(I-III期)。对于每个患者，我们都获得了诊断时的年龄、肿瘤大小、淋巴状态、ER状态、接受的治疗(放疗、化疗和三苯氧胺)以及死亡日期和原因的信息。对患者进行跟踪调查，从确诊之日起至乳腺癌死亡之日或最后一次随访之日。我们使用Kaplan-Meier方法根据诊断时的年龄(类别)估计ER阳性和ER阴性乳腺癌妇女15年的乳腺癌特异性生存率。我们使用COX比例风险模型来估计ER阳性乳腺癌患者(与ER阴性乳腺癌患者相比)死亡的调整后风险比，按确诊时的年龄分层。结果我们确定了1347名ER阳性乳腺癌患者(70.5%)和563名ER阴性乳腺癌患者(29.5%)。在队列中的所有1910名女性中，ER阳性乳腺癌患者15年的乳腺癌特定存活率精算率为77%，而ER阴性乳腺癌患者为70%(调整后的HR=0.69；95%CI为0.56-0.85；p=0.0006)。ER状态对预后的影响因确诊年龄不同而不同。在213名40岁前确诊的女性中，雌激素受体阳性乳腺癌患者15年的乳腺癌特异性存活率比雌激素受体阴性乳腺癌患者差(55比61%；调整后的HR=0.90；95%的可信区间0.57-1.41；p=0.64)。相比之下，在1697名年龄在40岁至75岁之间确诊的女性中，ER阳性乳腺癌患者15年的乳腺癌特异性生存率好于ER阴性乳腺癌患者(78vs.72%；调整后HR=0.6；95%CI0.47-0.76；p<；0.0001)。结论ER状态阳性是40岁或以上乳腺癌患者的有利预后因素，但在40岁之前诊断的乳腺癌患者中则不然。
Purpose To estimate the prognostic impact of estrogen receptor (ER)-status among women with primary invasive breast cancer, according to age at diagnosis.Methods We studied 1910 women with primary invasive breast cancer (stages I-III) who were treated at Women's College Hospital between 1987 and 2000. For each patient, we obtained information on age at diagnosis, tumour size, lymph node status, ER-status, treatments received (radiotherapy, chemotherapy and tamoxifen) and dates and causes of death. Patients were followed from the date of diagnosis until the date of death from breast cancer or the date of last follow-up. We used the Kaplan-Meier method to estimate the 15-year actuarial rates of breast cancer-specific survival for women with ER-positive and ER-negative breast cancer, according to age at diagnosis (categories). We used the Cox proportional hazards model to estimate the adjusted hazard ratios for death from breast cancer associated with positive ER-status (compared to negative ER-status), stratified by age at diagnosis.Results We identified 1347 women with ER-positive breast cancer (70.5%) and 563 women with ER-negative breast cancer (29.5%). Among all 1910 women in the cohort, the actuarial rate of breast cancer-specific survival at 15 years was 77% for those with ER-positive breast cancer compared to 70% for those with ER-negative breast cancer (adjusted HR = 0.69; 95% CI 0.56-0.85; p = 0.0006). The prognostic impact of ER-status differed according to age at diagnosis. Among 213 women diagnosed before age 40, breast cancer-specific survival at 15 years was worse for those with ER-positive breast cancer than for those with ER-negative breast cancer (55 vs. 61%; adjusted HR = 0.90; 95% CI 0.57-1.41; p = 0.64). In contrast, among 1697 women diagnosed between ages 40 and 75, breast cancer-specific survival at 15 years was better for those with ER-positive breast cancer than for those with ER-negative breast cancer (78 vs. 72%; adjusted HR = 0.60; 95% CI 0.47-0.76; p < 0.0001).Conclusions Positive ER-status is a favourable prognostic factor among women diagnosed with breast cancer at or above age 40, but not among women diagnosed before age 40.