Edwards Melissa J, Campbell Ian D, Lawrenson Ross A, Kuper-Hommel Marion J
Department of Surgery, Waikato Clinical School, University of Auckland, Hamilton, New Zealand.
Department of Population Health, University of Waikato, Hamilton, New Zealand.
Breast Cancer Res Treat. 2017 Aug;165(1):17-39. doi: 10.1007/s10549-017-4295-4. Epub 2017 May 20.
Patients with early breast cancer and coexistent comorbidities generally experience worse prognosis which may be in part related to inferior treatment. Randomised data on chemotherapy use and tolerance in comorbid patients are limited. We aimed to review the available literature regarding the use of chemotherapy in such patients.
A systematic search of databases was performed for English-language articles evaluating the impact of comorbidity on chemotherapy use for early breast cancer. Comorbidity was assessed as a specific condition, summary count or index. Outcomes of interest were receipt of chemotherapy, change in chemotherapy delivery and occurrence of toxicity.
Sixty studies met inclusion criteria for systematic review. Thirty-three studies evaluated receipt of chemotherapy, with 19 reporting reduced treatment, particularly with higher levels of comorbidity. Meta-analysis of 10 eligible studies returned odds ratios (OR's) of 0.88 [95% confidence interval (CI) 0.80-0.96] and 0.63 (95% CI 0.49-0.80) for receipt of chemotherapy by patients with comorbidity scores of 1 and ≥2, respectively, compared with no comorbidity. Comorbidity had a generally adverse impact on the quality of chemotherapy delivery, although outcomes were heterogeneous. Toxicity was greater in patients with comorbidity, with 10 out of 13 studies reporting greater odds of toxicity or hospitalisation during chemotherapy. Meta-analysis of three studies addressing chemotherapy-associated hospitalisation produced OR's of 1.42 (95% CI 1.20-1.67) and 2.23 (95% CI 1.46-3.39) for comorbidity scores of 1 and ≥2, respectively.
Compared with their non-comorbid counterparts, comorbid patients with early breast cancer receive less quality adjuvant chemotherapy and experience greater toxicity.
早期乳腺癌合并其他疾病的患者通常预后较差，这可能部分与治疗效果欠佳有关。关于合并症患者化疗使用情况及耐受性的随机数据有限。我们旨在回顾有关此类患者化疗使用的现有文献。
对数据库进行系统检索，查找评估合并症对早期乳腺癌化疗使用影响的英文文章。合并症被评估为一种特定疾病、汇总计数或指数。感兴趣的结果包括化疗的接受情况、化疗方案的改变以及毒性的发生情况。
60项研究符合系统评价的纳入标准。33项研究评估了化疗的接受情况，其中19项报告称治疗减少，尤其是合并症程度较高时。对10项符合条件的研究进行荟萃分析，合并症评分为1分和≥2分的患者接受化疗的比值比（OR）分别为0.88[95%置信区间（CI）0.80 - 0.96]和0.63（95%CI 0.49 - 0.80），与无合并症患者相比。合并症对化疗方案的质量总体上有不利影响，尽管结果存在异质性。合并症患者的毒性更大，13项研究中有10项报告化疗期间毒性或住院的几率更高。对三项涉及化疗相关住院的研究进行荟萃分析，合并症评分为1分和≥2分的患者的OR分别为1.42（95%CI 1.20 - 1.67）和2.23（95%CI 1.46 - 3.39）。
与无合并症的早期乳腺癌患者相比，合并症患者接受的辅助化疗质量较低，且毒性更大。
