Differential presentation and survival of de novo and recurrent metastatic breast cancer over time: 1990-2010.

Differential presentation and survival of de novo and recurrent metastatic breast cancer over time: 1990-2010.
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DOI:
10.1007/s10549-017-4529-5
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发表时间:
2018-01
影响因子:
3.8
通讯作者:
Kaplan HG
Kaplan HG
中科院分区:
医学2区
文献类型:
--
作者:
Malmgren JA;Mayer M;Atwood MK;Kaplan HG

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新发 (dnMBC) 和复发性转移性乳腺癌 (rMBC) 表现和随时间推移的生存率的差异尚未得到充分描述。一项回顾性队列研究,1990-2010 年,对 dnMBC 患者(诊断时为 IV 期)和随后发生远处转移复发的 rMBC 患者(初始诊断为 I-III 期)进行随访至 2015 年 [dnMBC = 247,rMBC = 911)]。分析包括分类变量的卡方检验、Kaplan-Meier 生存估计以及 Cox 比例调整风险比 (HzR) 和 95% 置信区间 (CI)。 疾病特异性生存期 (DSS) 是从诊断或远处复发到 BC 死亡的时间。随着时间的推移,1990-1998年、1999-2004年和2005-2010年,dnMBC发病率保持不变(3%),而rMBC发病率下降[18%至7%(p < 0.001)],dnMBC激素受体(HR)或her2-neu(HER2)状态没有变化,但rMBC HER2阳性病例减少,三阴性乳腺癌增加癌症 (HR 阴性/HER2 阴性)(p = 0.049)。五年期 dnMBC DSS 为 44%,而 rMBC 为 21%(p < 0.001)。五年期 dnMBC DSS 随着时间的推移有所改善 [28% 至 55% (p = 0.008)],而 rMBC 则恶化 [23% 至 13%,p = 0.065)]。更糟糕的 DSS 与 HR 阴性状态 (HzR = 1.63; 1.41, 1.89)、rMBC (HzR = 1.88; 1.58, 2.23)、年龄较大 (70 +) (HzR = 1.88; 1.58, 2.24)、> 1 个远处转移 (HzR 1.39; 1.58, 2.24) 相关。 1.20、1.62)和内脏显性疾病(HzR 1.22; 1.05、1.43)。 1998 年之后,HER2 阳性疾病与更好的 DSS 相关(HzR = 0.72,95% CI 0.56,0.93)。与 dnMBC 和 rMBC 之间生存差距扩大、不等价以及 rMBC 发病率降低相关的因素值得进一步研究。
Differences in de novo (dnMBC) and recurrent metastatic breast cancer (rMBC) presentation and survival over time have not been adequately described. A retrospective cohort study, 1990–2010, with follow up through 2015 of dnMBC patients (stage IV at diagnosis) and rMBC patients with subsequent distant metastatic recurrence (stage I–III initial diagnosis) [dnMBC = 247, rMBC = 911)]. Analysis included Chi squared tests of categorical variables, Kaplan–Meier survival estimates, and Cox proportional adjusted hazard ratios (HzR) and 95% confidence intervals (CI). Disease specific survival (DSS) was time from diagnosis or distant recurrence to BC death. Over time, 1990–1998, 1999–2004, and 2005–2010, dnMBC incidence was constant (3%) and rMBC incidence decreased [18% to 7% (p < 0.001)] with no change in dnMBC hormone receptor (HR) or her2-neu (HER2) status but a decrease in rMBC HER2-positive cases and increase in triple negative breast cancer (HR-negative/HER2-negative) (p = 0.049). Five-year dnMBC DSS was 44% vs. 21% for rMBC (p < 0.001). Five-year dnMBC DSS improved over time [28% to 55% (p = 0.008)] and rMBC worsened [23% to 13%, p = 0.065)]. Worse DSS was associated with HR-negative status (HzR = 1.63; 1.41, 1.89), rMBC (HzR = 1.88; 1.58, 2.23), older age (70 +) (HzR = 1.88; 1.58, 2.24), > 1 distant metastases (HzR 1.39; 1.20, 1.62), and visceral dominant disease (HzR 1.22; 1.05, 1.43). After 1998, HER2-positive disease was associated with better DSS (HzR = 0.72, 95% CI 0.56, 0.93). Factors associated with the widening survival gap and non-equivalence between dnMBC and rMBC and decreased rMBC incidence warrant further study.
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