按种族/民族划分的乳腺癌幸存者中的糖尿病及其他合并症：加利福尼亚乳腺癌生存联盟（CBCSC）
Diabetes and other comorbidities in breast cancer survival by race/ethnicity: the California Breast Cancer Survivorship Consortium (CBCSC).
作者信息
Wu Anna H, Kurian Allison W, Kwan Marilyn L, John Esther M, Lu Yani, Keegan Theresa H M, Gomez Scarlett Lin, Cheng Iona, Shariff-Marco Salma, Caan Bette J, Lee Valerie S, Sullivan-Halley Jane, Tseng Chiu-Chen, Bernstein Leslie, Sposto Richard, Vigen Cheryl
机构信息
Keck School of Medicine, University of Southern California, Los Angeles, California.
Stanford University School of Medicine, Stanford, California.
出版信息
Cancer Epidemiol Biomarkers Prev. 2015 Feb;24(2):361-8. doi: 10.1158/1055-9965.EPI-14-1140. Epub 2014 Nov 25.
BACKGROUND
The role of comorbidities in survival of patients with breast cancer has not been well studied, particularly in non-white populations.
METHODS
We investigated the association of specific comorbidities with mortality in a multiethnic cohort of 8,952 breast cancer cases within the California Breast Cancer Survivorship Consortium (CBCSC), which pooled questionnaire and cancer registry data from five California-based studies. In total, 2,187 deaths (1,122 from breast cancer) were observed through December 31, 2010. Using multivariable Cox proportional hazards regression, we estimated HRs and 95% confidence intervals (CI) for overall and breast cancer-specific mortality associated with previous cancer, diabetes, high blood pressure (HBP), and myocardial infarction.
RESULTS
Risk of breast cancer-specific mortality increased among breast cancer cases with a history of diabetes (HR, 1.48; 95% CI, 1.18-1.87) or myocardial infarction (HR, 1.94; 95% CI, 1.27-2.97). Risk patterns were similar across race/ethnicity (non-Latina white, Latina, African American, and Asian American), body size, menopausal status, and stage at diagnosis. In subgroup analyses, risk of breast cancer-specific mortality was significantly elevated among cases with diabetes who received neither radiotherapy nor chemotherapy (HR, 2.11; 95% CI, 1.32-3.36); no increased risk was observed among those who received both treatments (HR, 1.13; 95% CI, 0.70-1.84; P(interaction) = 0.03). A similar pattern was found for myocardial infarction by radiotherapy and chemotherapy (P(interaction) = 0.09).
CONCLUSION
These results may inform future treatment guidelines for patients with breast cancer with a history of diabetes or myocardial infarction.
IMPACT
Given the growing number of breast cancer survivors worldwide, we need to better understand how comorbidities may adversely affect treatment decisions and ultimately outcome.
背景
合并症在乳腺癌患者生存中的作用尚未得到充分研究，尤其是在非白人人群中。
方法
我们在加利福尼亚乳腺癌生存联盟（CBCSC）的一个多民族队列中，调查了8952例乳腺癌病例中特定合并症与死亡率的关联，该联盟汇总了来自加利福尼亚州五项研究的问卷和癌症登记数据。截至2010年12月31日，共观察到2187例死亡（其中1122例死于乳腺癌）。我们使用多变量Cox比例风险回归，估计了与既往癌症、糖尿病、高血压（HBP）和心肌梗死相关的全因死亡率和乳腺癌特异性死亡率的风险比（HR）及95%置信区间（CI）。
结果
有糖尿病病史（HR，1.48；95%CI，1.18 - 1.87）或心肌梗死病史（HR，1.94；95%CI，1.27 - 2.97）的乳腺癌病例中，乳腺癌特异性死亡风险增加。种族/族裔（非拉丁裔白人、拉丁裔、非裔美国人和亚裔美国人）、体型、绝经状态和诊断分期的风险模式相似。在亚组分析中，既未接受放疗也未接受化疗的糖尿病患者中，乳腺癌特异性死亡风险显著升高（HR，2.11；95%CI，1.32 - 3.36）；接受两种治疗的患者未观察到风险增加（HR，1.13；95%CI，0.70 - 1.84；P（交互作用） = 0.03）。放疗和化疗对心肌梗死的影响也有类似模式（P（交互作用） = 0.09）。
结论
这些结果可能为有糖尿病或心肌梗死病史的乳腺癌患者的未来治疗指南提供参考。
影响
鉴于全球乳腺癌幸存者数量不断增加，我们需要更好地了解合并症如何可能对治疗决策及最终结果产生不利影响。
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