Fallahpour Saber, Navaneelan Tanya, De Prithwish, Borgo Alessia
Affiliations: Surveillance and Cancer Registry (Fallahpour, Navaneelan, De) and ColonCancerCheck and Gastrointestinal Endoscopy (Borgo), Cancer Care Ontario, Toronto, Ont.
CMAJ Open. 2017 Sep 25;5(3):E734-E739. doi: 10.9778/cmajo.20170030.
The relation between breast cancer molecular subtype and survival has been studied in several jurisdictions, but limited information is available for Ontario. The aim of this study was to determine breast cancer survival by molecular subtype and to assess the effect on survival of selected demographic and tumour-based characteristics.
We extracted 29 833 breast cancer cases (in 26 538 girls and women aged ≥ 15 yr) diagnosed between 2010 and 2012 from the Ontario Cancer Registry. Cancers were categorized into 4 molecular subtypes: 1) luminal A (estrogen-receptor-positive and/or progesterone-receptor-positive [ER+ and/or PR+] and negative for human epidermal growth factor receptor 2 [HER2-]), 2) luminal B (ER+ and/or PR+/HER2+), 3) HER2-enriched (ER- and PR-/HER2+) and 4) triple-negative (ER- and PR-/HER2-). We estimated associations with predictor variables (age, stage at diagnosis, histologic type, comorbidity and place of residence [urban or rural]) using a multivariate Cox proportional hazards model. Likelihood ratio testing was used to evaluate differences in risk of death.
Luminal A was the most commonly diagnosed subtype (59.0%) and had the greatest survival, whereas triple-negative had the poorest survival. For all subtypes, a dose-response effect was observed between the hazard of death and age and stage at diagnosis, with the greatest effect found for the HER2-enriched subtype (age: hazard ratio [HR] 7.87 [95% confidence interval (CI) 3.68-11.81]; stage at diagnosis: HR 37.71 [95% CI 34.64-41.27]). Moderate comorbidity (Charlson Comorbidity Index score 1 or 2) was associated with increased risk of death for triple-negative cancers (HR 2.42 [95% CI 1.36-4.31]), and severe comorbidity (Charlson Comorbidity Index score ≥ 3) increased the risk for all molecular subtypes.
The results indicate the importance of including molecular subtype, along with age, stage at diagnosis and comorbidity, in assessing breast cancer survival. They highlight the need to address outcomes related to hormone-receptor-negative cancers, for which survival lags behind that for hormone-receptor-positive cancers.
在多个辖区对乳腺癌分子亚型与生存率之间的关系进行了研究，但安大略省的相关信息有限。本研究的目的是按分子亚型确定乳腺癌生存率，并评估选定的人口统计学和肿瘤相关特征对生存率的影响。
我们从安大略癌症登记处提取了2010年至2012年间诊断的29833例乳腺癌病例（涉及26538名年龄≥15岁的女性）。癌症被分为4种分子亚型：1）腔面A型（雌激素受体阳性和/或孕激素受体阳性[ER+和/或PR+]且人表皮生长因子受体2阴性[HER2-]），2）腔面B型（ER+和/或PR+/HER2+），3）HER2富集型（ER-和PR-/HER2+）和4）三阴性（ER-和PR-/HER2-）。我们使用多变量Cox比例风险模型估计与预测变量（年龄、诊断时分期、组织学类型、合并症和居住地点[城市或农村]）的关联。似然比检验用于评估死亡风险的差异。
腔面A型是最常诊断出的亚型（59.0%），生存率最高，而三阴性的生存率最差。对于所有亚型，在死亡风险与年龄和诊断时分期之间观察到剂量反应效应，HER2富集型的效应最大（年龄：风险比[HR]7.87[95%置信区间（CI）3.68 - 11.81]；诊断时分期：HR 37.71[95%CI 34.64 - 41.27]）。中度合并症（Charlson合并症指数评分为1或2）与三阴性癌症的死亡风险增加相关（HR 2.42[95%CI 1.36 - 4.31]），重度合并症（Charlson合并症指数评分≥3）会增加所有分子亚型的风险。
结果表明在评估乳腺癌生存率时，除年龄、诊断时分期和合并症外，纳入分子亚型很重要。它们凸显了应对与激素受体阴性癌症相关结局的必要性，这类癌症的生存率落后于激素受体阳性癌症。
