Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Clin Epidemiol. 2013 Nov 1;5(Suppl 1):39-46. doi: 10.2147/CLEP.S47152. eCollection 2013.
Previous studies have suggested that breast cancer survival in Denmark has improved, primarily in cancer patients without comorbidity. We therefore conducted a population-based cohort study to examine recent temporal changes in survival and mortality among breast cancer patients with different extents of comorbidity.
We used population-based medical and administrative registries to identify breast cancer patients diagnosed between 2000 and 2011 in the Central Denmark Region. We defined comorbid diseases according to the Charlson Comorbidity Index (CCI), including a history of hospitalization for comorbid disease up to 10 years before breast cancer diagnosis. We studied the impact of comorbidities on overall 1- and 5-year survival in different calendar time periods, using a hybrid analysis for survival prediction in the most recent calendar periods.
We included 9,329 breast cancer patients. The proportion of patients within different comorbidity categories remained stable from 2000 to 2011. One-year survival improved from 91% in 2000-2002 to 95% in 2009-2011, while 5-year survival improved from 72% to a predicted 78%. During the entire study period, comorbidity was a strong predictor of the survival of breast cancer patients. However, we observed improvements over time in 1- and 5-year survival for all comorbidity groups. During the 12-year study period, the estimated 5-year survival for patients with a high comorbidity disease burden (CCI score ≥3) increased from 25% to a predicted 50%, and their 5-year age-adjusted mortality hazard ratio (HR) fell from 4.0 (95% confidence interval [CI]: 3.0, 5.4) to 2.7 (95% CI: 2.0, 3.6), respectively, compared with patients with no comorbid disease.
Survival of breast cancer patients diagnosed in the Central Denmark Region improved from 2000 to 2011, regardless of the extent of comorbid disease.
先前的研究表明，丹麦的乳腺癌存活率有所提高，主要是在无合并症的癌症患者中。因此，我们进行了一项基于人群的队列研究，以检查不同合并症程度的乳腺癌患者近期生存和死亡率的变化。
我们使用基于人群的医疗和行政登记处，确定了在丹麦中部地区于 2000 年至 2011 年间诊断出的乳腺癌患者。我们根据 Charlson 合并症指数（CCI）定义了合并症疾病，包括在乳腺癌诊断前 10 年内因合并症住院的病史。我们使用最近日历期间生存预测的混合分析，研究了合并症对不同日历时间内整体 1 年和 5 年生存率的影响。
我们纳入了 9329 名乳腺癌患者。2000 年至 2011 年期间，不同合并症类别的患者比例保持稳定。1 年生存率从 2000-2002 年的 91%提高到 2009-2011 年的 95%，而 5 年生存率从 72%提高到预计的 78%。在整个研究期间，合并症是乳腺癌患者生存的重要预测因素。然而，我们观察到所有合并症组的 1 年和 5 年生存率都随时间有所提高。在 12 年的研究期间，患有高合并症疾病负担（CCI 评分≥3）的患者的 5 年预计生存率从 25%增加到 50%，而他们的 5 年年龄调整后的死亡率风险比（HR）从 4.0（95%置信区间[CI]：3.0，5.4）下降到 2.7（95% CI：2.0，3.6），与无合并症的患者相比。
无论合并症的严重程度如何，丹麦中部地区诊断出的乳腺癌患者的生存率从 2000 年到 2011 年都有所提高。
