Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium.
Department of Breast Surgery, University Hospital Herlev, Copenhagen, Denmark.
J Natl Cancer Inst. 2018 Apr 1;110(4):426-429. doi: 10.1093/jnci/djx206.
Safety of pregnancy in women with history of estrogen receptor (ER)-positive breast cancer remains controversial. In this multicenter case-control study, 333 patients with pregnancy after breast cancer were matched (1:3) to 874 nonpregnant patients of similar characteristics, adjusting for guaranteed time bias. Survival estimates were calculated using the Kaplan-Meier analysis; groups were compared with the log-rank test. All reported P values were two-sided. At a median follow-up of 7.2 years after pregnancy, no difference in disease-free survival was observed between pregnant and nonpregnant patients with ER-positive (hazard ratio [HR] = 0.94, 95% confidence interval [CI] = 0.70 to 1.26, P = .68) or ER-negative (HR = 0.75, 95% CI = 0.53 to 1.06, P = .10) disease. No overall survival (OS) difference was observed in ER-positive patients (HR = 0.84, 95% CI = 0.60 to 1.18, P = .32); ER-negative patients in the pregnant cohort had better OS (HR = 0.57, 95% CI = 0.36 to 0.90, P = .01). Abortion, time to pregnancy, breastfeeding, and type of adjuvant therapy had no impact on patients' outcomes. This study provides reassuring evidence on the long-term safety of pregnancy in breast cancer survivors, including those with ER-positive disease.
患有雌激素受体（ER）阳性乳腺癌的女性的妊娠安全性仍存在争议。在这项多中心病例对照研究中，对 333 名乳腺癌后妊娠的患者进行了匹配（1:3），与 874 名具有相似特征的未妊娠患者进行了匹配，以调整保证时间偏倚。使用 Kaplan-Meier 分析计算生存估计值；使用对数秩检验比较组。所有报告的 P 值均为双侧。在妊娠后中位随访 7.2 年后，ER 阳性（风险比 [HR] = 0.94，95%置信区间 [CI] = 0.70 至 1.26，P =.68）或 ER 阴性（HR = 0.75，95% CI = 0.53 至 1.06，P =.10）疾病患者中，妊娠患者与非妊娠患者在无病生存方面无差异。在 ER 阳性患者中未观察到总体生存（OS）差异（HR = 0.84，95% CI = 0.60 至 1.18，P =.32）；妊娠队列中的 ER 阴性患者具有更好的 OS（HR = 0.57，95% CI = 0.36 至 0.90，P =.01）。流产、妊娠时间、母乳喂养和辅助治疗类型对患者结局没有影响。这项研究为乳腺癌幸存者，包括患有 ER 阳性疾病的幸存者，提供了妊娠长期安全性的令人安心的证据。
