Sutter Institute for Medical Research, Sacramento, CA, USA.
Breast J. 2020 Sep;26(9):1729-1735. doi: 10.1111/tbj.13924. Epub 2020 Jun 2.
Concomitant comorbidity is a key factor in treatment decision-making for breast cancer. The aim of this study was to determine how the Charlson Comorbidity Index (CCI) affected treatment and risk of mortality of women with TNBC, the subtype with the poorest prognosis. We accessed 20 177 cases of TNBC from the California Cancer Registry 2000-2015 with documented Charlson Comorbidity Index (CCI). Cox Regression was used to compute the adjusted risk of breast cancer-specific mortality for a CCI of 1 (low comorbidity) and 2+ (high comorbidity) vs a CCI of 0 (no comorbidity). Logistic regression was used to compute the association of CCI with treatment of mastectomy, lumpectomy + radiation, and chemotherapy. Analyses were conducted separately for each stage. Patients with high comorbidity CCI (2+) were less likely to receive systemic chemotherapy irrespective of Stage. High comorbidity was associated with higher breast-specific mortality in all stages of disease. High comorbidity did not have an effect on the use of lumpectomy and radiation of stage 1 breast cancer but was associated with reduced use in stages 2-4. Comorbidity was not associated with decreased risk of mastectomy except for patients with high comorbidity in stage 3. Concomitant comorbidity influences treatment decisions and breast cancer-specific mortality in patients with TNBC.
合并症是乳腺癌治疗决策的关键因素。本研究旨在确定 Charlson 合并症指数 (CCI) 如何影响三阴性乳腺癌 (TNBC) 患者的治疗和死亡率，后者是预后最差的亚型。我们从加利福尼亚癌症登记处 2000-2015 年获取了 20177 例有记录的 Charlson 合并症指数 (CCI) 的 TNBC 病例。使用 Cox 回归计算 CCI 为 1（低合并症）和 2+（高合并症）与 CCI 为 0（无合并症）的乳腺癌特异性死亡率的调整风险。使用逻辑回归计算 CCI 与乳房切除术、肿块切除术+放疗和化疗治疗的相关性。分别对每个分期进行分析。无论分期如何，CCI 高（2+）的患者接受全身化疗的可能性较低。高合并症与所有疾病分期的乳腺癌特异性死亡率升高有关。高合并症对 1 期乳腺癌的肿块切除术和放疗没有影响，但与 2-4 期的减少使用相关。除了 3 期高合并症患者外，合并症与乳房切除术风险降低无关。合并症会影响 TNBC 患者的治疗决策和乳腺癌特异性死亡率。
