Prospective Observational Study of Breast Cancer Treatment Outcomes for UK Women Aged 1840 Years at Diagnosis: The POSH Study
Prospective Observational Study of Breast Cancer Treatment Outcomes for UK Women Aged 1840 Years at Diagnosis: The POSH Study
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DOI：
10.1093/jnci/djt134
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发表时间：
2013-07-01
影响因子：
10.3
通讯作者：
Eccles, Diana
中科院分区：
文献类型：
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作者：
Copson, Ellen;Eccles, Bryony;Eccles, Diana
年轻时患乳腺癌与预后不良有关。散发性和遗传性乳腺癌预后的前瞻性研究（POSH）旨在研究影响这一患者组预后的因素，2000年至2008年，2956例年龄在40岁或以下的患者被招募到英国多中心前瞻性观察性队列研究（POSH）。详细记录肿瘤病理学、疾病分期、接受的治疗和结局。采用Kaplan-Meier曲线评估总生存期（OS）和无远处转移间期（DDFI）。所有统计检验均为双侧检验，患者的中位年龄为36岁。中位肿瘤直径为22 mm，50%的患者有阳性淋巴结; 59%的肿瘤为3级，33.7%为雌激素受体（ER）阴性，24%为人表皮生长因子受体2（HER 2）阳性。ER阳性肿瘤患者的5年OS高于ER阴性肿瘤患者（85.0%，95%置信区间[CI] 83.2%至86.7% vs 75.7%，95% CI 72.8%至78.4%; P <0.001），但到8年时，生存率几乎相等。在HER 2阳性和HER 2阴性亚组中，ER阳性肿瘤患者的8年OS与ER阴性肿瘤患者相似。OS的灵活参数生存模型显示，与ER阴性肿瘤患者相比，ER阳性肿瘤患者的死亡风险随时间稳步增加，这些结果证实了年轻患者ER阴性肿瘤和早期复发的频率增加，并且还表明患有ER阳性肿瘤且HER 2-阴性或阳性疾病。
Breast cancer at a young age is associated with poor prognosis. The Prospective Study of Outcomes in Sporadic and Hereditary Breast Cancer (POSH) was designed to investigate factors affecting prognosis in this patient group.Between 2000 and 2008, 2956 patients aged 40 years or younger were recruited to a UK multicenter prospective observational cohort study (POSH). Details of tumor pathology, disease stage, treatment received, and outcome were recorded. Overall survival (OS) and distant disease-free interval (DDFI) were assessed using Kaplan-Meier curves. All statistical tests were two-sided.Median age of patients was 36 years. Median tumor diameter was 22mm, and 50% of patients had positive lymph nodes; 59% of tumors were grade 3, 33.7% were estrogen receptor (ER) negative, and 24% were human epidermal growth factor receptor 2 (HER2) positive. Five-year OS was higher for patients with ER-positive than ER-negative tumors (85.0%, 95% confidence interval [CI] 83.2% to 86.7% vs 75.7%, 95% CI 72.8% to 78.4%; P < .001), but by eight years, survival was almost equal. The eight-year OS of patients with ER-positive tumors was similar to that of patients with ER-negative tumors in both HER2-positive and HER2-negative subgroups. The flexible parametric survival model for OS shows that the risk of death increases steadily over time for patients with ER-positive tumors in contrast to patients with ER-negative tumors, where risk of death peaked at two years.These results confirm the increased frequency of ER-negative tumors and early relapse in young patients and also demonstrate the equally poor longer-term outlook of young patients who have ER-positive tumors with HER2-negative or -positive disease.