乳腺癌幸存者的加速衰老及其与死亡率和癌症复发的关系。
Accelerated aging in breast cancer survivors and its association with mortality and cancer recurrence.
机构信息
Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 600 (IMPH), Nashville, TN, USA.
Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, People's Republic of China.
出版信息
Breast Cancer Res Treat. 2020 Apr;180(2):449-459. doi: 10.1007/s10549-020-05541-5. Epub 2020 Feb 4.
PURPOSE
To prospectively investigate accelerated aging and its association with total mortality and breast cancer-specific mortality/recurrence among breast cancer survivors.
METHODS
This study included 4218 female breast cancer patients enrolled into a population-based cohort study approximately 6-month post-diagnosis. Information on aging-related symptoms (i.e., self-rated overall health condition, energy level, depression, sleep difficulty, and quality) was collected at 18- and 36-month post-diagnosis surveys. Information on overall health, daily function impairments, survival status, and recurrence was collected at 10-year post-diagnosis survey. Record linkages with vital statistics were conducted to collect mortality information. Cox proportional hazards model was applied.
RESULTS
Among 3041 10-year survivors with a mean age of 63.7 ± 9.7 years, respectively, 52.3%, 19.0%, and 27.6% reported poor health, limitation in daily activity, and climbing floors. Age-specific prevalence revealed that breast cancer survivors reached similar prevalence of the functional limitations 5-10 years earlier than cancer-free women. At the 18-month post-diagnosis survey, respectively, 47.0%, 72.5%, and 25.1% of survivors reported unsatisfied overall health condition, reduced energy level, and depression symptoms. After a median follow-up of 10.9 years, low self-rated overall health, low energy level, and depression were significantly associated with increased total mortality, with hazard ratios (HRs; 95% confidence intervals [CI]) of 3.14 (2.43, 4.06), 1.49 (1.20, 1.84), and 1.59 (1.21, 2.09), respectively. Low self-rated health was associated with breast cancer-specific mortality/recurrence (HR 1.85, 95% CI 1.30, 2.65). No significant association was found for sleep difficulty and quality.
CONCLUSION
Aging-related physical changes/symptoms are commonly presented at 18 months after breast cancer diagnosis and are associated with worse prognosis.
IMPACT
Our findings highlight the concern of accelerated aging among breast cancer survivors.
目的
前瞻性研究加速衰老及其与乳腺癌幸存者总死亡率和乳腺癌特异性死亡率/复发的关系。
方法
本研究纳入了大约在诊断后 6 个月时参加基于人群队列研究的 4218 名女性乳腺癌患者。在诊断后 18 个月和 36 个月的调查中收集了与衰老相关的症状信息（即自我评估的总体健康状况、能量水平、抑郁、睡眠困难和睡眠质量）。在诊断后 10 年的调查中收集了整体健康状况、日常功能障碍、生存状况和复发的信息。进行记录链接以收集死亡率信息。应用 Cox 比例风险模型。
结果
在 3041 名 10 年幸存者中，平均年龄为 63.7±9.7 岁，分别有 52.3%、19.0%和 27.6%报告健康状况不佳、日常活动受限和爬楼梯困难。特定年龄的患病率显示，乳腺癌幸存者达到与无癌症女性相似的功能障碍患病率早 5-10 年。在诊断后 18 个月的调查中，分别有 47.0%、72.5%和 25.1%的幸存者报告总体健康状况不满意、能量水平降低和抑郁症状。在中位随访 10.9 年后，自我评估的总体健康状况不佳、低能量水平和抑郁与总死亡率的增加显著相关，风险比（HR；95%置信区间[CI]）分别为 3.14（2.43，4.06）、1.49（1.20，1.84）和 1.59（1.21，2.09）。自我评估的健康状况不佳与乳腺癌特异性死亡率/复发相关（HR 1.85，95%CI 1.30，2.65）。睡眠困难和睡眠质量与无显著关联。
结论
与衰老相关的身体变化/症状在乳腺癌诊断后 18 个月经常出现，并与预后较差相关。
影响
我们的研究结果强调了乳腺癌幸存者加速衰老的问题。
Zotero 插件