Breast Imaging Group, Ninewells Hospital and Medical School, Mailbox 4, Dundee, DD1 9SY, Scotland.
Medical Oncology, Ninewells Hospital and Medical School, Mailbox 4, Dundee, DD1 9SY, Scotland.
Int J Clin Oncol. 2020 Oct;25(10):1786-1792. doi: 10.1007/s10147-020-01733-7. Epub 2020 Jul 2.
Our aim is to assess whether the poor breast cancer specific survival (BCSS) seen in women with breast cancer and impaired renal function can be explained by associations with other prognostic factors.
The study group was a consecutive series of patients undergoing breast ultrasound (US) who had invasive breast cancer (n = 1171). All women had their US diameter and mean stiffness (kPa) at shear wave elastography (SWE) recorded. The core biopsy grade and receptor status were noted. Core biopsy of abnormal axillary nodes and the patient referral source was also noted. Survival including cause of death was ascertained. Comorbidities at diagnosis were recorded. Patients were divided into those with a GFR<60 ("renal group"), those with other comorbidities and those with none. BCSS was assessed using Kaplan-Meier survival curves and Cox proportional hazards regression.
One thousand, one hundred and forty-one patients constituted the study group. 107 (9%) patients had impaired renal function, 182 (16%) had other comorbidities while 852 (75%) had no comorbidities. Mean follow-up was 5.8 years. 109 breast cancer and 122 non-breast cancer deaths occurred. BCSS in the renal group was significantly worse than the other groups. Women with renal comorbidity were older, more likely to present symptomatically, have a pre-operative diagnosis of axillary metastases, and have larger and stiffer cancers. Cox proportional hazards regression showed that renal impairment maintained independent significance.
The poor BCSS in women with impaired renal function is partially explained by advanced tumour stage at presentation. However, impaired renal function maintains an independent prognostic effect.
我们的目的是评估患有乳腺癌和肾功能受损的女性中较差的乳腺癌特异性生存（BCSS）是否可以通过与其他预后因素的关联来解释。
研究组是连续系列接受乳房超声（US）检查的浸润性乳腺癌患者（n=1171）。所有女性均记录了超声直径和剪切波弹性成像（SWE）的平均硬度（kPa）。记录了核心活检分级和受体状态。还记录了异常腋窝淋巴结的核心活检和患者转诊来源。确定了包括死亡原因在内的生存情况。记录了诊断时的合并症。将患者分为肾小球滤过率（GFR）<60 的患者（“肾功能组”）、有其他合并症的患者和无合并症的患者。使用 Kaplan-Meier 生存曲线和 Cox 比例风险回归评估 BCSS。
1141 例患者构成了研究组。107 例（9%）患者存在肾功能受损，182 例（16%）患者存在其他合并症，852 例（75%）患者无合并症。平均随访时间为 5.8 年。发生 109 例乳腺癌和 122 例非乳腺癌死亡。肾功能组的 BCSS 明显差于其他组。患有肾功能合并症的女性年龄更大，更可能出现症状，术前诊断为腋窝转移，且肿瘤更大、更硬。Cox 比例风险回归显示肾功能损害具有独立意义。
肾功能受损女性的 BCSS 较差部分是由于就诊时肿瘤分期较晚所致。然而，肾功能受损仍然具有独立的预后作用。
