丹麦基于人群的队列研究：乳腺癌患者骨转移和骨骼相关事件的发生率。

Incidence of bone metastases and skeletal-related events in breast cancer patients: a population-based cohort study in Denmark.

机构信息

Department of Clinical Epidemiology, Aarhus University Hospital, Ole Worms Alle 1150, DK-8000 Århus C., Denmark.

出版信息

BMC Cancer. 2011 Jan 24;11:29. doi: 10.1186/1471-2407-11-29.

DOI:10.1186/1471-2407-11-29

PMID:21261987

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3037922/

Abstract

BACKGROUND

Breast cancer (BrCa) is the most commonly diagnosed cancer among women in the industrialized world. More than half of women presenting with metastatic BrCa develop bone metastases. Bone metastases increase the risk of skeletal-related events (SREs), defined as pathological fractures, spinal cord compression, bone pain requiring palliative radiotherapy, and orthopaedic surgery. Both bone metastases and SREs are associated with unfavorable prognosis and greatly affect quality of life. Few epidemiological data exist on SREs after primary diagnosis of BrCa and subsequent bone metastasis. We therefore estimated the incidence of bone metastases and SREs in newly-diagnosed BrCa patients in Denmark from 1999 through 2007.

METHODS

We estimated the overall and annual incidence of bone metastases and SREs in newly-diagnosed breast cancer patients in Denmark from January 1, 1999 to December 31, 2007 using the Danish National Patient Registry (DNPR), which covers all Danish hospitals. We estimated the cumulative incidence of bone metastases and SREs and associated 95% confidence intervals (CI) using the Kaplan-Meier method.

RESULTS

Of the 35,912 BrCa patients, 178 (0.5%) presented with bone metastases at the time of primary breast cancer diagnosis, and of these, 77 (43.2%) developed an SRE during follow up. A total of 1,272 of 35,690 (3.6%) BrCa patients without bone metastases at diagnosis developed bone metastases during a median follow-up time of 3.4 years. Among these patients, 590 (46.4%) subsequently developed an SRE during a median follow-up time of 0.7 years. Incidence rates of bone metastases were highest the first year after the primary BrCa diagnosis, particularly among patients with advanced BrCa at diagnosis. Similarly, incidence rates of a first SRE was highest the first year after first diagnosis of a bone metastasis.

CONCLUSIONS

The high incidence of SREs following the first year after first diagnosis of a bone metastasis underscores the need for early BrCa detection and research on effective treatments to delay the onset of SREs.

摘要

背景

乳腺癌（BrCa）是工业化国家中女性最常见的癌症。超过一半的转移性 BrCa 女性患者会发展为骨转移。骨转移增加了骨骼相关事件（SREs）的风险，这些事件定义为病理性骨折、脊髓压迫、需要姑息性放疗的骨痛以及骨科手术。骨转移和 SREs 都与不良预后相关，并极大地影响生活质量。关于原发性 BrCa 诊断后和随后发生骨转移的 SREs 很少有流行病学数据。因此，我们估计了 1999 年至 2007 年期间丹麦新诊断的 BrCa 患者的骨转移和 SRE 的发生率。

方法

我们使用丹麦全国患者登记处（DNPR），该登记处涵盖了所有丹麦医院，估计了 1999 年 1 月 1 日至 2007 年 12 月 31 日期间丹麦新诊断的乳腺癌患者的总体和年度骨转移和 SRE 发生率。我们使用 Kaplan-Meier 方法估计了骨转移和 SRE 的累积发生率及其 95%置信区间（CI）。

结果

在 35912 名 BrCa 患者中，178 名（0.5%）在原发性乳腺癌诊断时即出现骨转移，其中 77 名（43.2%）在随访期间发生了 SRE。在没有骨转移的 35690 名 BrCa 患者中，共有 1272 名（3.6%）在中位随访 3.4 年后发生了骨转移。在这些患者中，590 名（46.4%）随后在中位随访 0.7 年内发生了 SRE。骨转移的发生率在原发性 BrCa 诊断后的第一年最高，尤其是在诊断时患有晚期 BrCa 的患者中。同样，首次诊断为骨转移后的第一年，首次 SRE 的发生率最高。