Kaplan Henry G, Malmgren Judith A, Atwood Mary K, Calip Gregory S
Department of Oncology, Swedish Cancer Institute, Seattle, Washington.
HealthStat Consulting, Seattle, Washington.
Cancer. 2015 Aug 1;121(15):2553-61. doi: 10.1002/cncr.29371. Epub 2015 Apr 14.
The extent to which improvements over time in breast cancer survival are related to earlier detection by mammography or to more effective treatments is not known.
At a comprehensive cancer care center, the authors conducted a retrospective cohort study of women ages 50 to 69 years who were diagnosed with invasive breast cancer (stages I through III) and were followed over 3 periods (1990-1994, 1995-1999, and 2000-2007). Data were abstracted from patient charts and included detection method, diagnosis, treatment, and follow-up for vital status in the institutional breast cancer registry (n = 2998). The method of detection was categorized as patient or physician detected or mammography detected. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for 5-year disease-specific survival in relation to detection method and treatment factors, and differences in survival were analyzed using the Kaplan-Meier method.
Fifty-eight percent of breast cancers were mammography detected, and 42% were patient or physician detected; 56% of tumors were stage I, 31% were stage II, and 13% were stage III. The average length of follow-up was 10.71 years. The combined 5-year disease-specific survival rate was 89% from 1990 to 1994, 94% from 1995 to 1999, and 96% from 2000 to 2007 (P < .001). In an adjusted model, mammography detection (HR, 0.43; 95% CI, 0.27-0.70), hormone therapy (HR, 0.47; 95% CI, 0.30-0.75), and taxane-containing chemotherapy (HR, 0.61; 95% CI, 0.37-0.99) were significantly associated with a decreased risk of disease-specific mortality.
Better breast cancer survival over time was related to mammography detection, hormone therapy, and taxane-containing chemotherapy. Treatment improvements alone are not sufficient to explain the observed survival improvements over time.
乳腺癌生存率随时间的改善在多大程度上与通过乳房X线摄影术的早期检测或更有效的治疗相关尚不清楚。
在一家综合癌症护理中心，作者对年龄在50至69岁之间、被诊断为浸润性乳腺癌（I至III期）并在三个时间段（1990 - 1994年、1995 - 1999年和2000 - 2007年）接受随访的女性进行了一项回顾性队列研究。数据从患者病历中提取，包括检测方法、诊断、治疗以及机构乳腺癌登记处（n = 2998）的生命状态随访。检测方法分为患者或医生检测到的以及乳房X线摄影术检测到的。使用Cox比例风险模型来估计与检测方法和治疗因素相关的5年疾病特异性生存的调整风险比（HRs）和95%置信区间（CIs），并使用Kaplan - Meier方法分析生存差异。
58%的乳腺癌是通过乳房X线摄影术检测到 的，42%是由患者或医生检测到的；56%的肿瘤为I期，31%为II期，13%为III期。平均随访时间为10.71年。1990年至1994年的5年疾病特异性生存率综合为89%，1995年至1999年为94%，2000年至2007年为96%（P < 0.001）。在一个调整模型中，乳房X线摄影术检测（HR，0.43；95% CI，0.27 - 0.70）、激素治疗（HR，0.47；95% CI，0.30 - 0.75）和含紫杉烷的化疗（HR，0.61；95% CI，0.37 - 0.99）与疾病特异性死亡风险降低显著相关。
随着时间推移乳腺癌生存率的提高与乳房X线摄影术检测、激素治疗和含紫杉烷的化疗有关。仅治疗方面的改善不足以解释随时间观察到的生存率提高。
