Cetin Karynsa, Christiansen Christian Fynbo, Sværke Claus, Jacobsen Jacob Bonde, Sørensen Henrik Toft
Center for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California, USA.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
BMJ Open. 2015 Apr 29;5(4):e007702. doi: 10.1136/bmjopen-2015-007702.
Since population-based data on prognostic factors affecting survival in patients with breast cancer with bone metastasis (BM) are currently limited, we conducted this nationwide retrospective cohort study to examine the prognostic role of disease stage at breast cancer diagnosis and length of BM-free interval (BMFI).
Denmark.
2427 women with a breast cancer diagnosis between 1997 and 2011 in the Danish Cancer Registry and a concurrent or subsequent BM diagnosis in the Danish National Registry of Patients.
Survival (crude) based on Kaplan-Meier method and mortality risk (crude and adjusted for age, year of diagnosis, estrogen receptor status and comorbidity) based on Cox proportional hazards regression analyses by stage of disease at breast cancer diagnosis and by length of BMFI (time from breast cancer to BM diagnosis), following patients from BM diagnosis until death, emigration or until 31 December 2012, whichever came first.
Survival decreased with more advanced stage of disease at the time of breast cancer diagnosis; risk of mortality during the first year following a BM diagnosis was over two times higher for those presenting with metastatic versus localised disease (adjusted HR=2.12 (95% CI 1.71 to 2.62)). With respect to length of BMFI, survival was highest in women with a BMFI <1 year (ie, in those who presented with BM at the time of breast cancer diagnosis or were diagnosed within 1 year). However, among patients with a BMFI ≥1 year, survival increased with longer BMFI (1-year survival: 39.9% (95% CI 36.3% to 43.6%) for BMFI 1 to <3 years and 52.6% (95% CI 47.4% to 57.6%) for BMFI ≥5 years). This pattern was also observed in multivariate analyses.
Stage of disease at breast cancer diagnosis and length of BMFI appear to be important prognostic factors for survival following BM.
由于目前基于人群的影响骨转移（BM）乳腺癌患者生存的预后因素数据有限，我们开展了这项全国性回顾性队列研究，以探讨乳腺癌诊断时疾病分期和无骨转移间期（BMFI）长度的预后作用。
丹麦。
2427名在1997年至2011年间于丹麦癌症登记处被诊断为乳腺癌且在丹麦国家患者登记处同时或随后被诊断为BM的女性。
基于Kaplan-Meier方法的生存（粗生存率）以及基于Cox比例风险回归分析的死亡风险（粗风险以及根据年龄、诊断年份、雌激素受体状态和合并症调整后的风险），根据乳腺癌诊断时的疾病分期和BMFI长度（从乳腺癌到BM诊断的时间）进行分析，对患者从BM诊断开始随访直至死亡、移民或直至2012年12月31日（以先发生者为准）。
乳腺癌诊断时疾病分期越晚，生存率越低；BM诊断后第一年，转移性疾病患者的死亡风险是局限性疾病患者的两倍多（调整后风险比=2.12（95%置信区间1.71至2.62））。关于BMFI长度，BMFI<1年的女性生存率最高（即那些在乳腺癌诊断时即出现BM或在1年内被诊断为BM的女性）。然而，在BMFI≥1年的患者中，生存率随BMFI延长而增加（1年生存率：BMFI为1至<3年时为39.9%（95%置信区间36.3%至43.6%），BMFI≥5年时为52.6%（95%置信区间47.4%至57.6%））。多变量分析中也观察到了这种模式。
乳腺癌诊断时的疾病分期和BMFI长度似乎是BM后生存的重要预后因素。
