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乳腺癌后发生的第二原发性肺癌:一项基于人群的6269名女性的研究。

Second Primary Lung Cancer After Breast Cancer: A Population-Based Study of 6,269 Women.

作者信息

Wang Rong, Yin Zhiqiang, Liu Lingxiang, Gao Wen, Li Wei, Shu Yongqian, Xu Jiali

机构信息

Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

出版信息

Front Oncol. 2018 Oct 9;8:427. doi: 10.3389/fonc.2018.00427. eCollection 2018.

Abstract

Breast cancer (BC) and lung cancer are the most two common cancers with highest morbidity and mortality for women. With prolonged survival, there comes the possibility that BC patients will develop second primary cancers. We evaluate the characteristics, incidence and survival of second primary non-small cell lung cancer (BC-NSCLC) and small cell lung cancer (BC-SCLC) after breast cancer. Second primary lung cancer risks using standardized incidence ratios (SIRs) [95% confidence intervals (95% CIs)] were calculated among breast cancer patients in SEER-18 (2000-2014). Survival outcomes were also analyzed for both BC-NSCLC and BC-SCLC. A total of 6,269 second lung cancer patients after a localized or regional BC were identified. The incidence rate was modestly higher compared to the general population (SIR = 1.03; 95%CI: 1.00-1.06). For ER-, PR- and HER2- groups, SIRs were 1.26, 1.16, 1.13, respectively (all < 0.05). Triple negative breast cancer (TNBC) patients have an even higher incidence rate of lung cancer (SIR = 1.59, 95%CI: 1.29-1.94). Elevated SIRs were also observed among the following groups: within 1 year after BC diagnosed, a young age at BC diagnosed, black people, poorly or undifferentiated histological grade of breast cancer. Median survival (MST) after localized, regional and distant BC-NSCLC was 68.0, 26.0, and 6.0m. Five-year survival rates for BC-NSCLC were 53.9, 29.8 and 5.7% in each stage, which were significantly higher compared to first primary NSCLC (all < 0.001). ER-/PR- or TNBC were unfavorable prognostic factors for BC-NSCLC. The survival rates of BC-SCLC were no significant different compared to first primary SCLC. BC patients, especially for TNBC, are at a high risk of developing second primary lung cancers. BC history may be a favorable prognostic factor for NSCLC (but not SCLC) patients. Clinicians should closely follow up BC patients with high-risk factors.

摘要

乳腺癌(BC)和肺癌是女性中发病率和死亡率最高的两种最常见癌症。随着生存期延长,乳腺癌患者有可能发生第二原发性癌症。我们评估了乳腺癌后第二原发性非小细胞肺癌(BC-NSCLC)和小细胞肺癌(BC-SCLC)的特征、发病率和生存率。在监测、流行病学和最终结果(SEER)-18(2000 - 2014年)的乳腺癌患者中,使用标准化发病比(SIRs)[95%置信区间(95% CIs)]计算第二原发性肺癌风险。还分析了BC-NSCLC和BC-SCLC的生存结局。共识别出6269例局限性或区域性乳腺癌后的第二原发性肺癌患者。其发病率略高于一般人群(SIR = 1.03;95%CI:1.00 - 1.06)。对于雌激素受体(ER)阴性、孕激素受体(PR)阴性和人表皮生长因子受体2(HER2)阴性组,SIRs分别为1.26、1.16、1.13(均P < 0.05)。三阴性乳腺癌(TNBC)患者的肺癌发病率更高(SIR = 1.59,95%CI:1.29 - 1.94)。在以下组中也观察到SIRs升高:乳腺癌诊断后1年内、乳腺癌诊断时年龄较小、黑人、乳腺癌组织学分级差或未分化。局限性、区域性和远处性BC-NSCLC后的中位生存期(MST)分别为68.0个月、26.0个月和6.0个月。BC-NSCLC各阶段的5年生存率分别为53.9%、29.8%和5.7%,与第一原发性NSCLC相比显著更高(均P < 0.001)。ER阴性/PR阴性或TNBC是BC-NSCLC的不良预后因素。BC-SCLC的生存率与第一原发性SCLC相比无显著差异。乳腺癌患者,尤其是TNBC患者,发生第二原发性肺癌的风险很高。乳腺癌病史可能是NSCLC(但不是SCLC)患者的有利预后因素。临床医生应密切随访具有高危因素的乳腺癌患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d86/6189405/0260c98c1b75/fonc-08-00427-g0001.jpg

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