马来西亚这个亚太国家的一家机构内，乳腺癌患者生存率的改善——两个时间段的趋势

Improvement in survival of breast cancer patients - trends over two time periods in a single institution in an Asia Pacific country, Malaysia.

作者信息

Taib Nur Aishah, Akmal Mn, Mohamed I, Yip Cheng-Har

机构信息

Department of Surgery, University Malaya Medical Centre, Faculty of Medicine, Kuala Lumpur, Malaysia.

出版信息

Asian Pac J Cancer Prev. 2011;12(2):345-9.

PMID:21545192

Abstract

BACKGROUND

There is improvement in breast cancer survival in the developed world, but information on breast cancer survival trends in the Asia Pacific region is limited. The aim of the study was to evaluate survival trends and factors that affect survival in Malaysia.

METHODS

Two prospective groups of 423 and 965 newly diagnosed breast cancer patients in University of Malaya Medical Centre, Kuala Lumpur, Malaysia diagnosed in two time periods ie. 1993 to 1997 and in 1998 to 2002 were studied. Vital status was obtained from the National Registry of Births and Deaths. The overall survival was calculated from the date of diagnosis to the date of death from any cause. The survival differences between the two groups were analysed using the log-rank or Peto-Wilcoxon method. Survival estimates and independent prognostic factors were estimated by the Kaplan-Meier method and multivariate analysis using Cox proportional hazard models. P values less than 0.05 were considered statistically significant. Analyses were performed using SPlus 2000 Professional Release 2.

RESULTS AND DISCUSSION

Median follow-up for the two groups were 55 months (SD 29.2 months) in the first group and 52 months (SD 24.43) in the second group. There was improvement in 5-year observed survival from 58.4% (CI 0.54-0.63) to 75.7% (CI 0.73-0.79). The improvement in survival was significantly seen in all co-variates (p< 0.05) except for those aged 40 years and below (p= 0.27), tumour size 2 to 5 cm (p=0.11), grade 3 (p=0.32) and patients with Stage IV disease (p= 0.80). Stage of disease, lymph node (LN) involvement, size and grade were identified as independent prognostic factors in cohort one. For the second cohort; stage and LN involvement remained independent factors with the addition of ER status and ethnicity.

CONCLUSIONS

There was improvement in 5-year observed survival. Besides known prognostic factors, Malay ethnicity was an independent prognostic factor.

摘要

背景

在发达国家，乳腺癌患者的生存率有所提高，但关于亚太地区乳腺癌生存趋势的信息有限。本研究的目的是评估马来西亚的生存趋势以及影响生存的因素。

方法

对马来西亚吉隆坡马来亚大学医学中心两个时间段（即1993年至1997年和1998年至2002年）新诊断的423例和965例乳腺癌患者这两个前瞻性队列进行研究。从国家出生和死亡登记处获取生命状态信息。总生存时间从诊断日期计算至任何原因导致的死亡日期。使用对数秩检验或Peto-Wilcoxon方法分析两组之间的生存差异。通过Kaplan-Meier方法和使用Cox比例风险模型的多变量分析来估计生存情况和独立预后因素。P值小于0.05被认为具有统计学意义。使用SPlus 2000 Professional Release 2进行分析。

结果与讨论

第一组的中位随访时间为55个月（标准差29.2个月），第二组为52个月（标准差24.43个月）。5年观察生存率从58.4%（可信区间0.54 - 0.63）提高到75.7%（可信区间0.73 - 0.79）。除了40岁及以下患者（p = 0.27）、肿瘤大小为2至5厘米的患者（p = 0.11）、3级患者（p = 0.32）和IV期疾病患者（p = 0.80）外，在所有协变量中均显著观察到生存率的提高（p < 0.05）。疾病分期、淋巴结受累情况、肿瘤大小和分级被确定为队列一中的独立预后因素。对于第二个队列，除了疾病分期和淋巴结受累外，雌激素受体（ER）状态和种族也成为独立因素。