Kiderlen Mandy, de Glas Nienke A, Bastiaannet Esther, van de Water Willemien, de Craen Anton J M, Guicherit Onno R, Merkus Jos W S, Extermann Martine, van de Velde Cornelis J H, Liefers Gerrit-Jan
Department of Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands,
Breast Cancer Res Treat. 2014 May;145(1):185-92. doi: 10.1007/s10549-014-2917-7. Epub 2014 Mar 28.
Older breast cancer patients often suffer from comorbid diseases, which may influence life expectancy. The aim of this study was to assess the impact of specific comorbidities on overall survival and distant recurrence free period (DRFP) of older breast cancer patients. Patients were included from the population-based FOCUS cohort which contains 3,672 breast cancer patients aged 65 years or older. The impact of comorbidity on overall survival and DRFP was analyzed using multivariable Cox proportional hazard models and Poisson regression models. Median follow-up time was 6.8 years (range 0-14.0). Irrespective of age; the number of comorbid diseases was significantly associated with worse overall survival [hazard ratio (HR) per increasing number of comorbid diseases: 1.20, 95 % confidence interval (CI) 1.13-1.27 and HR 1.09, 95 % CI 1.05-1.13 for age <75 and age ≥ 75, respectively]. Median follow-up time for DRFP was 5.7 years (range 0-14.0). An increasing number of comorbid diseases was associated with a decreasing risk of metastases among patients aged ≥ 75 (HR 0.94, 95 % CI 0.87-1.02), whereas an increasing risk was shown for patients aged <75 (HR 1.09, 95 % CI 1.01-1.19). This study shows that in older breast cancer, patients overall survival and DRFP are influenced by comorbidity. This reiterates that patient outcome is not only influenced by breast cancer, and non-cancer-related factors should be taken into account.
老年乳腺癌患者常患有合并症，这可能会影响预期寿命。本研究的目的是评估特定合并症对老年乳腺癌患者总生存期和无远处复发生存期（DRFP）的影响。研究对象来自基于人群的FOCUS队列，该队列包含3672例65岁及以上的乳腺癌患者。使用多变量Cox比例风险模型和泊松回归模型分析合并症对总生存期和DRFP的影响。中位随访时间为6.8年（范围0 - 14.0年）。无论年龄如何，合并症的数量与较差的总生存期显著相关[每增加一种合并症的风险比（HR）：分别为1.20，95%置信区间（CI）1.13 - 1.27，年龄<75岁者为1.09，95%CI 1.05 - 1.13，年龄≥75岁者]。DRFP的中位随访时间为5.7年（范围0 - 14.0年）。在≥75岁的患者中，合并症数量增加与转移风险降低相关（HR 0.94，95%CI 0.87 - 1.02），而在<75岁的患者中则显示风险增加（HR 1.09，95%CI 1.01 - 1.19）。本研究表明，在老年乳腺癌患者中，总生存期和DRFP受合并症影响。这再次强调患者的预后不仅受乳腺癌影响，还应考虑非癌症相关因素。
