Dodds Linda, Fell Deshayne B, Joseph K S, Dewar Ron, Scott Heather, Platt Robert, Aronson Kristan J
Perinatal Epidemiology Research Unit, Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada.
Obstet Gynecol. 2008 May;111(5):1167-73. doi: 10.1097/AOG.0b013e31816fd778.
To investigate the influence of time since childbirth and other pregnancy factors on the prognosis of premenopausal breast cancer.
Women who delivered an infant in Nova Scotia, Canada, between 1980 and 2001 were identified from a provincial perinatal database and linked to the Nova Scotia Cancer Registry to determine primary breast cancer diagnoses among women aged younger than 50 years. Relative risks and Cox proportional hazards ratios were calculated to quantify the relationship of time from childbirth to diagnosis and other pregnancy factors to the extent of disease at diagnosis and on survival after breast cancer diagnosis.
Of the 123,323 women who delivered an infant during the study period, 716 women were diagnosed with invasive breast cancer. Women with less than 5 years between their last delivery and diagnosis were more likely to be diagnosed with later-stage disease and had poorer survival even after adjusting for stage of disease (less than 2 years, adjusted hazards ratio 2.1, 95% confidence interval 1.2-3.9; 2-4 years, hazards ratio 1.6, 95% confidence interval 0.9-2.8) compared with women with 5 years or more. For every 13 women with less than 2 years between delivery and diagnosis, one excess death will occur, compared with women with 5 or more years between delivery and diagnosis.
A time interval of less than 2 years (and 2-4 years) between childbirth and breast cancer diagnosis worsens the prognosis in a dose-response fashion. Clinicians should be aware of these findings when examining women in the first 5 years after a delivery.
II.
探讨产后时间及其他妊娠因素对绝经前乳腺癌预后的影响。
从加拿大新斯科舍省的省级围产期数据库中识别出1980年至2001年在该省分娩的妇女，并与新斯科舍省癌症登记处建立联系，以确定50岁以下女性中的原发性乳腺癌诊断。计算相对风险和Cox比例风险比，以量化从分娩到诊断的时间以及其他妊娠因素与诊断时疾病程度和乳腺癌诊断后生存率之间的关系。
在研究期间分娩的123,323名妇女中，有716名被诊断患有浸润性乳腺癌。与分娩与诊断间隔5年或更长时间的女性相比，最后一次分娩与诊断间隔不到5年的女性更有可能被诊断为晚期疾病，并且即使在调整疾病分期后生存率也较差（间隔不到2年，调整后风险比2.1，95%置信区间1.2 - 3.9；2 - 4年，风险比1.6，95%置信区间0.9 - 2.8）。与分娩与诊断间隔5年或更长时间的女性相比，每13名分娩与诊断间隔不到2年的女性中就会有1例额外死亡。
分娩与乳腺癌诊断之间的时间间隔小于2年（以及2 - 4年）会以剂量反应方式使预后恶化。临床医生在产后头5年检查女性时应了解这些发现。
II级。
