Tubtimhin Sopit, Promthet Supannee, Suwanrungruang Krittika, Supaattagorn Pongsatorn
Doctor of Public Health Program, Faculty of Public Health, Khon Kaen University, Thailand. Email:
Asian Pac J Cancer Prev. 2018 Nov 29;19(11):3167-3174. doi: 10.31557/APJCP.2018.19.11.3167.
Background and Purpose: This study focused on molecular subtypes and prognostic factors for survival of preand post-menopausal breast cancer patients. Methods: A retrospective cohort study was performed on 523 patients with invasive carcinoma of the breast treated at Ubon Ratchathani Cancer Hospital,Thailand from 2002 to 2016. Patient characteristics were collected based on a systematic chart audit from medical records. Prognostic factors were performed by observe survival analysis. A Cox regression model was used to calculate hazard ratios of death, taking into account the age and menopause status, molecular subtype, stage of disease, histological grade, lymphatic and vascular invasion, resection margin, hormone receptor expression, and treatment modality. Results: The median time from the diagnosis of invasive breast cancer to the last follow-up or death was 10.2 [95% CI = 9.28-11.95] years in premenopausal women, and 7.4 [95% CI = 6.48-8.44] years in postmenopausal cases. The overall survival estimates at 5 and 10 years for younger woman of 71.2% and 51.8% respectively, appeared slightly better than the 68.3% and 40.9% for postmenopausal women [HRadj = 1.27, 95% CI =0.99-1.63]. In the multivariate analysis, 3 prognostic indicators significantly predicted a worse overall survival in premenopausal patients, triple negative subtype [HRadj = 6.03, 95% CI = 1.94-18.74], HER2-enriched status [HRadj = 4.11, 95% CI = 1.59-10.65] and stage III [HRadj = 2.73, 95% CI = 1.10-6.79]. Statistically significant increased risk of death in postmenopausal patients was noted for only chemotherapy after mastectomy [HRadj = 8.76, 95% CI = 2.88-26.61], and for a Luminal B status [HRadj = 3.55, 95% CI = 1.47-8.53]. Conclusion: Postmenopausal women with invasive breast cancer experience a significantly shorter survival than do their premenopausal counterparts. The predictors of worse overall survival were molecular subtype, stage of disease and type of treatment administered.
本研究聚焦于绝经前和绝经后乳腺癌患者的分子亚型及生存预后因素。方法：对2002年至2016年在泰国乌汶叻差他尼癌症医院接受治疗的523例浸润性乳腺癌患者进行了一项回顾性队列研究。基于对病历的系统图表审核收集患者特征。通过观察生存分析评估预后因素。采用Cox回归模型计算死亡风险比，同时考虑年龄、绝经状态、分子亚型、疾病分期、组织学分级、淋巴和血管侵犯、手术切缘、激素受体表达及治疗方式。结果：绝经前女性从浸润性乳腺癌诊断至最后一次随访或死亡的中位时间为10.2[95%CI = 9.28 - 11.95]年，绝经后患者为7.4[95%CI = 6.48 - 8.44]年。年轻女性5年和10年的总生存估计分别为71.2%和51.8%，略高于绝经后女性的68.3%和40.9%[校正风险比(HRadj)= 1.27，95%CI = 0.99 - 1.63]。在多因素分析中，3个预后指标显著预测绝经前患者总生存较差，即三阴性亚型[HRadj = 6.03，95%CI = 1.94 - 18.74]、HER2富集状态[HRadj = 4.11，95%CI = 1.59 - 10.65]和III期[HRadj =
