Li Shuling, Liu Jiannong, Virnig Beth A, Collins Allan J
Chronic Disease Research Group, Minneapolis Medical Research Foundation, 914 South 8th Street, Suite S2.100, Minneapolis, MN, 55404, USA.
Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
Breast Cancer Res Treat. 2017 Feb;161(3):515-524. doi: 10.1007/s10549-016-4074-7. Epub 2016 Dec 8.
We studied elderly Medicare enrollees newly diagnosed with early-stage breast cancer to examine the association between adjuvant chemotherapy and acute kidney injury (AKI).
Using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we conducted a retrospective cohort study including women diagnosed with stages I-III breast cancer at ages 66-89 years between 1992 and 2007. We performed one-to-one matching on time-dependent propensity score on the day of adjuvant chemotherapy initiation within 6 months after the first cancer-directed surgery based on the estimated probability of chemotherapy initiation at each day for each patient, using a Cox proportional hazards model. We estimated the cumulative incidence of AKI using Kaplan-Meier methods. We used Cox proportional hazards models to evaluate the association between chemotherapy and the risk of AKI, and compared the risk among major chemotherapy types.
The study included 28,048 women. The 6-month cumulative incidence of AKI was 0.80% for chemotherapy-treated patients, compared with 0.30% for untreated patients (P < 0.001). Adjuvant chemotherapy was associated with a nearly threefold increased risk of AKI [hazard ratio (HR) 2.73; 95% CI 1.8-4.1]. Compared with anthracycline-based chemotherapy, the HRs (95% CIs) were 1.66 (0.94-2.91), 0.88 (0.53-1.47), and 1.15 (0.57-2.32) for taxane-based, CMF, and other chemotherapy, respectively.
Our findings showed that adjuvant chemotherapy was associated with increased risk of AKI in elderly women diagnosed with early-stage breast cancer. The risk seemed to vary by regimen type, but the differences were not statistically significant.
我们对新诊断为早期乳腺癌的老年医疗保险参保者进行了研究，以探讨辅助化疗与急性肾损伤（AKI）之间的关联。
利用关联的监测、流行病学和最终结果（SEER）-医疗保险数据库，我们进行了一项回顾性队列研究，纳入了1992年至2007年间66至89岁诊断为I-III期乳腺癌的女性。我们根据每位患者每天化疗起始的估计概率，在首次癌症导向手术后6个月内辅助化疗开始之日，使用Cox比例风险模型对时间依赖性倾向评分进行一对一匹配。我们使用Kaplan-Meier方法估计AKI的累积发病率。我们使用Cox比例风险模型评估化疗与AKI风险之间的关联，并比较主要化疗类型之间的风险。
该研究纳入了28048名女性。化疗治疗患者的AKI 6个月累积发病率为0.80%，未治疗患者为0.30%（P<0.001）。辅助化疗与AKI风险增加近三倍相关[风险比（HR）2.73；95%CI 1.8-4.1]。与基于蒽环类药物的化疗相比，基于紫杉烷类、CMF和其他化疗的HR（95%CI）分别为1.66（0.94-2.91）、0.88（0.53-1.47）和1.15（0.57-2.32）。
我们的研究结果表明，辅助化疗与诊断为早期乳腺癌的老年女性AKI风险增加相关。风险似乎因治疗方案类型而异，但差异无统计学意义。
