Strasser-Weippl Kathrin, Ramchandani Ritesh, Fan Lei, Li Junjie, Hurlbert Marc, Finkelstein Dianne, Shao Zhi-Ming, Goss Paul E
Wilhelminen Hospital, Vienna, Austria.
Breast Cancer Res Treat. 2015 Jan;149(1):255-61. doi: 10.1007/s10549-014-3219-9. Epub 2014 Dec 14.
Breast cancer (BC) has been associated with pregnancy if diagnosed within 5-10 years after delivery (pregnancy-associated BC, PABC). PABC carries a poor prognosis compared to sporadic BC in Western populations. Data are limited regarding PABC in Asian populations, where longer periods of breastfeeding, higher birth rates and a lower median age of BC at diagnosis have been noted, all of which are known to influence prognosis. We used two datasets of women treated for early BC in Shanghai 1990-2012 (n = 10,161 and n = 7,411). For the analysis of BC risk after pregnancy we compared the distribution of pregnancy in our dataset to that in Shanghai using age-specific fertility rates. For disease-free survival (DFS) evaluation, we restricted our data to women ≤45 years. Women <30 years had a significantly elevated BC risk within 5 years of completing a pregnancy compared to women who had not been pregnant in the previous 5 years. In women aged 20-24 the relative risk (RR) was 3.33 (P = 0.012), and for women aged 25-29 the RR was 1.76 (P = 0.0074). For women >30, the RR was decreased. Patients with PABC had a higher risk of recurrence or death (hazard ratio (HR) for DFS 1.72, P = 0.019) compared to women with non-PABC by univariable analysis. Age was eliminated from the multivariable model by backward selection, resulting in tumor stage (3 versus 1, HR 3.08, P < .001) and recent pregnancy (HR 1.62, P < 0.05) as significant independent prognosticators. Having had a full-term pregnancy in the previous 5 years was associated with a 62 % increased risk of recurrence. We show that recent full-term pregnancy significantly elevates BC risk in women <30 in Shanghai, and that women diagnosed with PABC have a particularly adverse prognosis. Health care providers and women in Asian populations should be made aware of these results.
如果在分娩后5至10年内被诊断出患有乳腺癌（BC），则与妊娠相关（妊娠相关乳腺癌，PABC）。在西方人群中，与散发性乳腺癌相比，PABC的预后较差。关于亚洲人群中PABC的数据有限，在亚洲人群中，母乳喂养时间更长、出生率更高且乳腺癌诊断时的年龄中位数更低，所有这些因素都已知会影响预后。我们使用了1990 - 2012年在上海接受早期乳腺癌治疗的两个女性数据集（n = 10,161和n = 7,411）。为了分析妊娠后的乳腺癌风险，我们使用特定年龄生育率将数据集中妊娠的分布与上海的情况进行比较。为了评估无病生存期（DFS），我们将数据限制在年龄≤45岁的女性。与过去5年未怀孕的女性相比，<30岁的女性在完成妊娠后的5年内患乳腺癌的风险显著升高。在20 - 24岁的女性中，相对风险（RR）为3.33（P = 0.012），在25 - 29岁的女性中，RR为1.76（P = 0.0074）。对于>30岁的女性，RR降低。单因素分析显示，与非PABC的女性相比，PABC患者复发或死亡的风险更高（DFS的风险比（HR）为
1.72，P = 0.019）。通过向后选择从多变量模型中剔除年龄，结果显示肿瘤分期（3期与1期，HR 3.08，P <.001）和近期妊娠（HR 1.62，P < 0.05）是显著的独立预后因素。过去5年内有过足月妊娠与复发风险增加62%相关。我们表明，近期足月妊娠显著提高了上海<30岁女性患乳腺癌的风险，并且被诊断为PABC的女性预后特别不良。应让亚洲人群中的医疗保健提供者和女性了解这些结果。
