Kaiser Permanente Southern California, Department of Research & Evaluation, 100 South Los Robles Avenue, 2nd Floor, Pasadena, CA 91101, USA.
Cancer Epidemiol Biomarkers Prev. 2012 Oct;21(10):1848-55. doi: 10.1158/1055-9965.EPI-12-0474. Epub 2012 Sep 18.
We investigated the impact of breast cancer molecular subtypes and treatment on survival in a cohort of medically insured women followed for more than 20 years.
We examined 934 female members of an integrated health care delivery system newly diagnosed with invasive breast cancer between 1988 and 1995 and followed them through 2008. Tumors were classified into four molecular subtypes on the basis of their expression profile: luminal A; luminal B; basal-like; and HER2-enriched. We followed women from the surgery date to death, health plan disenrollment, or study's end. HR and 95% confidence intervals (CI) were fit using Cox proportional hazards models adjusting for cancer treatments and tumor characteristics.
A total of 223 (23.9%) women died because of breast cancer during the 21-year study period. Compared with women with luminal A tumors, women with HER2-enriched (HR 2.56, 95% CI 1.53-4.29) and luminal B tumors (HR 1.96, 95% CI: 1.08-3.54) had roughly a two-fold increased adjusted risk of breast cancer mortality. In addition, the survival curves suggest that risk of late mortality persists in women with luminal A tumors.
Among women with health care coverage, molecular subtypes were important predictors of breast cancer mortality. Women with HER2-enriched tumors and luminal B subtypes had the poorest survival despite adjusting for important covariates.
In a cohort followed for more than 20 years, women with HER2-enriched tumors had worse survival, but interestingly, the survival curve for women with luminal A tumors continued to steadily decline after 10 years of follow-up.
我们调查了乳腺癌分子亚型和治疗对超过 20 年随访的医疗保险女性患者生存的影响。
我们检查了 1988 年至 1995 年间新诊断为浸润性乳腺癌的一个综合医疗保健提供系统的 934 名女性成员，并对她们进行了 2008 年的随访。根据其表达谱将肿瘤分为四种分子亚型： luminal A；luminal B；基底样；和 HER2 富集型。我们从手术日期开始随访女性，直到死亡、退出健康计划或研究结束。使用 Cox 比例风险模型拟合 HR 和 95%置信区间 (CI)，调整癌症治疗和肿瘤特征。
在 21 年的研究期间，共有 223 名（23.9%）女性死于乳腺癌。与 luminal A 肿瘤女性相比，HER2 富集型（HR 2.56，95%CI 1.53-4.29）和 luminal B 肿瘤（HR 1.96，95%CI：1.08-3.54）的女性乳腺癌死亡的调整风险大致增加了两倍。此外，生存曲线表明，luminal A 肿瘤女性的晚期死亡风险仍然存在。
在有医疗保险的女性中，分子亚型是乳腺癌死亡率的重要预测因素。尽管调整了重要的协变量，但 HER2 富集型肿瘤和 luminal B 亚型的女性生存最差。
在一个随访超过 20 年的队列中，HER2 富集型肿瘤的女性生存较差，但有趣的是，luminal A 肿瘤女性的生存曲线在 10 年随访后继续稳步下降。
