Department of Surgery, Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, AZ; Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Mayo Clinic Arizona, Phoenix, AZ.
Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Mayo Clinic Arizona, Phoenix, AZ; Department of Biostatistics, Mayo Clinic Arizona, Phoenix, AZ.
J Am Coll Surg. 2019 Jul;229(1):30-36.e1. doi: 10.1016/j.jamcollsurg.2019.03.013. Epub 2019 Mar 29.
The majority of newly diagnosed breast cancers in the US are in women aged older than 65 years who can have additional comorbidities. Balancing the risks and benefits of treatment should take into account these competing risks of death.
The Surveillance, Epidemiology, and End Results Program-Medicare database was used to identify women with stage I breast cancer undergoing operations from 2004-2012. Using neural network analysis, comorbidities associated with mortality were grouped into clinically relevant categories. Cumulative incidence graphs and Fine and Gray competing risk regression analyses were used to study the association of age, race, comorbidity groupings, and tumor variables with 3 competing mortality outcomes: dead of disease (DOD), dead of other cancers (DOC), and non-cancer death (NCD).
The overall cumulative incidence of mortality was 4.9% for DOD, 3.7% for DOC, and 21.3% for NCD for the 47,220 patients studied. For all patients, the 5- and 8-year probability of DOD was 3% and 4.7%, for DOC 1.9% and 3.5%, and for NCD 9.8% and 18.9%, respectively. The presence of any major comorbidity (eg cardiovascular or neurologic disorders) significantly increased the probability of NCD, and estrogen receptor status was the strongest predictor of DOD. Given patient age, comorbidity, and estrogen receptor status, an estimate of competing risks of death from DOD, DOC, and NCD can be calculated.
To aid clinical decision making, we quantify competing risks of death in patients with stage I breast cancer by taking into account patient age, comorbidity, and estrogen receptor status.
美国大多数新诊断的乳腺癌发生在年龄大于 65 岁的女性中，这些患者可能有其他合并症。在权衡治疗的风险和益处时，应考虑到这些死亡的竞争风险。
利用监测、流行病学和最终结果计划-医疗保险数据库，确定了 2004 年至 2012 年间接受手术的 I 期乳腺癌女性。通过神经网络分析，将与死亡率相关的合并症分为具有临床相关性的类别。使用累积发生率图和 Fine 和 Gray 竞争风险回归分析，研究年龄、种族、合并症分组和肿瘤变量与 3 种竞争死亡结局的关系：死于疾病（DOD）、死于其他癌症（DOC）和非癌症死亡（NCD）。
在 47220 例患者中，总体死亡率的累积发生率为 DOD 4.9%，DOC 3.7%，NCD 21.3%。对于所有患者，5 年和 8 年的 DOD 概率分别为 3%和 4.7%，DOC 为 1.9%和 3.5%，NCD 为 9.8%和 18.9%。任何主要合并症（如心血管或神经系统疾病）的存在显著增加了 NCD 的概率，雌激素受体状态是 DOD 的最强预测因素。考虑到患者年龄、合并症和雌激素受体状态，可以估计 DOD、DOC 和 NCD 的死亡竞争风险。
为了帮助临床决策，我们通过考虑患者年龄、合并症和雌激素受体状态，量化了 I 期乳腺癌患者死亡的竞争风险。
