Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge.
Eastern Cancer Registration and Information Centre Unit C, Cambridge.
Ann Oncol. 2010 Feb;21(2):291-296. doi: 10.1093/annonc/mdp301. Epub 2009 Jun 7.
The reasons for variation in survival in breast cancer are multifactorial.
From 1999 to 2003, the vital status of 9051 cases of invasive breast cancer was identified in the Eastern Region of England. Survival analysis was by Cox proportional hazards regression. Data were analysed separately for patients aged <70 years and those older due to differences in treatment policies.
Overall 5-year survival was 78%. In patients aged <70 years, significant differences in survival lost their formal significance after adjustment for detection mode and node status, although this remained close to statistical significance with some residual differences between relative hazards. There was significant negative ecological correlation between proportion with nodes positive or not examined and 9-year survival rates. Patients with estrogen receptor (ER) status unknown were at significantly higher risk of dying than ER-positive patients. There was a clear trend of increasing hazard of dying with increasing deprivation. Survival differences in women aged > or =70 years were related to whether surgery was included as part of treatment.
This variation in treatment and survival may be attributed to lack of information, in particular nodal and ER status, thereby impacting on staging and prescription of adjuvant therapy.
乳腺癌患者生存率存在差异的原因是多方面的。
1999 年至 2003 年，在英格兰东部地区确定了 9051 例浸润性乳腺癌患者的存活状态。生存分析采用 Cox 比例风险回归。由于治疗政策的差异，分别对年龄<70 岁和年龄>70 岁的患者进行数据分析。
总体 5 年生存率为 78%。在年龄<70 岁的患者中，在调整了检测模式和淋巴结状态后，生存差异的显著性失去了正式意义，尽管在某些相对危险之间仍存在接近统计学显著性的差异。淋巴结阳性或未检测到淋巴结的比例与 9 年生存率之间存在显著的负生态相关性。雌激素受体（ER）状态未知的患者死亡风险明显高于 ER 阳性患者。随着贫困程度的增加，死亡风险明显增加。年龄>70 岁的女性生存差异与手术是否作为治疗的一部分有关。
这种治疗和生存的差异可能归因于缺乏信息，特别是淋巴结和 ER 状态，从而影响分期和辅助治疗的处方。
