Postpartum diagnosis demonstrates a high risk for metastasis and merits an expanded definition of pregnancy-associated breast cancer.
Postpartum diagnosis demonstrates a high risk for metastasis and merits an expanded definition of pregnancy-associated breast cancer.
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DOI：
10.1007/s10549-013-2437-x
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发表时间：
2013-04
影响因子：
3.8
通讯作者：
Borges, Virginia F.
中科院分区：
文献类型：
--
作者：
Callihan, Eryn B.;Gao, Dexiang;Jindal, Sonali;Lyons, Traci R.;Manthey, Elizabeth;Edgerton, Susan;Urquhart, Alexander;Schedin, Pepper;Borges, Virginia F.
关键词：
以前的研究报告了关于妊娠相关乳腺癌(PABC)预后的相互矛盾的数据。我们的目的是在一名年轻女性的乳腺癌队列中检查产后诊断对母亲预后的影响。我们在1981年至2011年期间在科罗拉多大学医院和位于科罗拉多州爱德华兹的邵氏癌症中心对年龄为≤45岁的女性进行了一项回顾性队列研究，这些女性被诊断为乳腺癌(n=1619)。将乳腺癌病例按分娩至确诊时间分组：未分娩125例，妊娠24例，产后5年以上136例，产后10年以上130例，≥产后10年以上者147例，分析其临床病理特征及远处复发死亡的风险。与未分娩的病例相比，怀孕后确诊但在产后五年内确诊的病例，远处复发(HR 2.80，95%CI：1.12-6.57)和死亡(HR 2.65，95%CI：1.09-6.42)的风险大约增加三倍。与未分娩的病例(分别为14.8%和98.0%)相比，最后一次分娩后五年内确诊的病例显示出较高的五年远处复发概率(31.1%)和较低的五年总体生存概率(65.8%)。经生物学亚型、分期和诊断年份调整后，在产后第一个五年诊断为乳腺癌的孕妇预后较差。我们建议，PABC的定义应该包括产后至少五年内确诊的病例，以便更好地描述产后诊断带来的风险增加。基于新出现的临床前和流行病学数据，我们建议将怀孕和产后病例作为PABC的不同亚类进行研究，以阐明怀孕和怀孕后的事件(如乳房复旧)对乳腺癌的风险。此外，我们强调产后乳腺癌作为进一步研究的一个领域的重要性，以降低PABC增加的转移潜力和死亡率。本文的在线版本(doi：10.1007/s10549-0132437-x)包含补充材料，可供授权用户使用。
Previous studies report conflicting data on outcomes of pregnancy-associated breast cancer (PABC). Our aim was to examine the effect of a postpartum diagnosis on maternal prognosis in a young women’s breast cancer cohort. We conducted a retrospective cohort study of women age ≤45 years, diagnosed with breast cancer (n = 619) during 1981–2011 at the University of Colorado Hospital and The Shaw Cancer Center in Edwards, CO. Breast cancer cases were grouped according to time between giving birth and diagnosis: nulliparous (n = 125), pregnant (n = 24), < 5 years postpartum (n = 136), >5—<10 postpartum (n = 130), and ≥10 years postpartum (n = 147), to examine the clinicopathologic features and the risk of distance recurrence and death. Cases diagnosed after pregnancy, but within five-years postpartum, had an approximate three fold increased risk of distant recurrence (HR 2.80, 95 % CI: 1.12–6.57) and death (HR 2.65, 95 % CI: 1.09–6.42) compared to nulliparous cases. Postpartum cases diagnosed within five years of last childbirth demonstrated a higher five-year distant recurrence probability (31.1 %) and a markedly lower five-year overall survival probability (65.8 %) compared to nulliparous cases (14.8 and 98.0 %, respectively). A diagnosis of breast cancer during the first five-years postpartum confers poorer maternal prognoses after adjustment for biologic subtype, stage, and year of diagnosis. We propose that the definition of PABC should include cases diagnosed up to at least five-years postpartum to better delineate the increased risk imparted by a postpartum diagnosis. Based on emerging preclinical and epidemiologic data, we propose that pregnant and postpartum cases be researched as distinct subsets of PABC to clarify the risk imparted by pregnancy and the events subsequent to pregnancy, such as breast involution, on breast cancer. Further, we highlight the importance of postpartum breast cancer as an area for further research to reduce the increased metastatic potential and mortality of PABC. The online version of this article (doi:10.1007/s10549-013-2437-x) contains supplementary material, which is available to authorized users.
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