Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Clin Breast Cancer. 2019 Apr;19(2):e297-e305. doi: 10.1016/j.clbc.2018.12.005. Epub 2018 Dec 12.
The aim of this study was to characterize treatment trends and outcomes of women who have preexisting cardiovascular disease (CVD) prior to the diagnosis of breast cancer.
This represented a retrospective, population-based cohort study that analyzed pooled data from the provincial cancer registry, physician billing claims, hospital discharge abstracts, ambulatory care, and the 2011 census in a large Canadian province. Multivariable logistic regression was performed to identify the associations of CVD with breast cancer treatment and outcomes. Kaplan-Meier analyses were conducted and survival was compared between CVD and non-CVD groups. Cox regression models were constructed to determine the effect of CVD on overall and cancer-specific survival.
A total of 25,594 women with breast cancer were eligible and included in the current analysis. Preexisting CVD was associated with a lower likelihood of receiving chemotherapy (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.48-0.66; P < .0001) and radiotherapy (OR, 0.75; 95% CI, 0.67-0.83; P < .0001), but a higher probability of undergoing mastectomy (OR, 1.13; 95% CI, 1.03-1.25; P = .011). Unadjusted Kaplan-Meier analyses showed that individuals with preexisting CVD experienced worse median overall and cancer-specific survival when compared with those without CVD (87 vs. 150 months and 106 vs. 131 months, respectively; both P < .0001). Adjusting for measured confounders, the presence of preexisting CVD continued to predict for worse overall survival (hazard ratio, 1.55; 95% CI, 1.43-1.67; P < .0001), but not cancer-specific survival (hazard ratio, 1.11; 95% CI, 0.98-1.27; P = .099).
Patients with breast cancer with preexisting CVD are less likely to receive recommended treatment for their cancer and more likely to exhibit worse overall survival.
本研究旨在描述患有乳腺癌前已存在心血管疾病（CVD）的女性的治疗趋势和结局。
这是一项回顾性、基于人群的队列研究，分析了加拿大一个大省的省级癌症登记处、医生计费索赔、住院病历摘要、门诊护理和 2011 年人口普查的数据。采用多变量逻辑回归来确定 CVD 与乳腺癌治疗和结局的关联。进行 Kaplan-Meier 分析，并比较 CVD 和非 CVD 组之间的生存情况。构建 Cox 回归模型以确定 CVD 对总生存率和癌症特异性生存率的影响。
共有 25594 名患有乳腺癌的女性符合条件并纳入当前分析。患有 CVD 与接受化疗的可能性降低（比值比 [OR]，0.56；95%置信区间 [CI]，0.48-0.66；P<0.0001）和放疗（OR，0.75；95%CI，0.67-0.83；P<0.0001）的可能性降低相关，但接受乳房切除术的可能性更高（OR，1.13；95%CI，1.03-1.25；P=0.011）。未经调整的 Kaplan-Meier 分析显示，与无 CVD 患者相比，患有 CVD 的患者中位总生存和癌症特异性生存较差（分别为 87 个月和 150 个月，106 个月和 131 个月；均 P<0.0001）。调整了测量的混杂因素后，CVD 的存在仍然预示着总生存率更差（风险比，1.55；95%CI，1.43-1.67；P<0.0001），但与癌症特异性生存率无关（风险比，1.11；95%CI，0.98-1.27；P=0.099）。
患有乳腺癌且患有 CVD 的患者接受癌症推荐治疗的可能性较低，且总体生存率更差。
