Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
J Natl Cancer Inst. 2017 Oct 1;109(10). doi: 10.1093/jnci/djx041.
Over half of breast cancer patients discontinue their adjuvant hormone therapy, permanently or temporarily. We aimed to identify predictors of treatment restarting after discontinuation of adjuvant hormone therapy and to test the hypothesis that treatment restarting is associated with better breast cancer outcomes.
We conducted a population-based cohort study by linking data from the Stockholm-Gotland Breast Cancer Register, the Swedish Prescribed Drug Register, and a self-reported questionnaire. We followed women diagnosed with breast cancer (Stockholm, Sweden, 2005-2008) from their first prescription of tamoxifen or aromatase inhibitors through January 31, 2015, and categorized them as continuers (n = 1 607), restarters (n = 953), and nonrestarters (n = 511) of adjuvant hormone therapy. All statistical tests were two-sided.
Factors that decrease the likelihood of treatment restarting included younger age (<50 years), higher Charlson Comorbidity Score (≥2), smaller tumor size (<20 mm), human epidermal growth factor receptor 2 negative, lymph node negative, family history of breast cancer negative, using hormone therapy, using symptom relieving drugs, and switching therapy between tamoxifen and aromatase inhibitors. Restarting adjuvant hormone therapy was statistically significantly associated with prolonged disease-free survival, with an adjusted hazard ratio of 0.61 (95% confidence interval = 0.43 to 0.87, P = .006) for restarters vs nonrestarters.
Our study provides-for the first time to our knowledge-evidence that restarting adjuvant hormone therapy is associated with better breast cancer outcomes. Clinicians now have further evidence to encourage patients to restart their treatment after discontinuation of adjuvant hormone therapy.
超过一半的乳腺癌患者会永久性或暂时性地停止辅助激素治疗。我们旨在确定辅助激素治疗中断后重新开始治疗的预测因素，并检验治疗重新开始与更好的乳腺癌结局相关的假设。
我们通过链接斯德哥尔摩-哥塔兰乳腺癌登记处、瑞典处方药物登记处和一份自我报告的调查问卷中的数据开展了一项基于人群的队列研究。我们随访了 2005-2008 年期间在斯德哥尔摩被诊断为乳腺癌的女性，随访至 2015 年 1 月 31 日，她们首次接受他莫昔芬或芳香化酶抑制剂治疗，我们将她们分为辅助激素治疗的继续治疗者（n=1607）、重新开始治疗者（n=953）和未重新开始治疗者（n=511）。所有统计检验均为双侧检验。
降低治疗重新开始可能性的因素包括年龄较小（<50 岁）、Charlson 合并症评分较高（≥2）、肿瘤体积较小（<20mm）、人表皮生长因子受体 2 阴性、淋巴结阴性、乳腺癌家族史阴性、使用激素治疗、使用缓解症状药物以及他莫昔芬和芳香化酶抑制剂之间的治疗转换。重新开始辅助激素治疗与无病生存时间延长具有统计学显著相关性，重新开始治疗者与未重新开始治疗者相比，调整后的风险比为 0.61（95%置信区间为 0.43 至 0.87，P=0.006）。
我们的研究首次提供了证据，表明重新开始辅助激素治疗与更好的乳腺癌结局相关。临床医生现在有了进一步的证据来鼓励患者在停止辅助激素治疗后重新开始治疗。
