Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.
Portuguese Institute of Oncology Francisco Gentil (IPO Coimbra), Coimbra, Portugal.
Breast Cancer Res Treat. 2020 Sep;183(2):439-450. doi: 10.1007/s10549-020-05761-9. Epub 2020 Jul 10.
Endocrine therapy (ET) is the mainstream adjuvant treatment for ER-positive breast cancer (BC). We analysed 9293 ER-positive BC patients diagnosed in nine European countries in 2009-2013 to investigate how comorbidities at diagnosis, age, stage and subtype affected ET use over time, and relapse.
Adjusted odds ratios (ORs) and 95% confidence intervals (95%CIs) of receiving ET were estimated according to Charlson comorbidity, age, stage and subtype using logistic regression. The 2-year cumulative incidence and adjusted sub-hazard ratios (SHRs) of relapse were estimated using competing risk analysis, with all-cause death as the competing event. The z-test was used to assess differences in the proportion of patients receiving ET in 1996-1998 and 2009-2013.
Ninety percent of the patients started adjuvant ET, range 96% (Belgium, Estonia, Slovenia, Spain)-75% (Switzerland). ORs of starting ET were lower for women aged > 75 years, with severe comorbidities, or luminal B HER2-positive cancer. The factors independently increasing the risk of relapse were: not receiving ET (SHR 2.26, 95%CI 1.02-5.03); severe comorbidity (SHR 1.94, 95%CI 1.06-3.55); luminal B, either HER2 negative (SHR 3.06, 95%CI 1.61-5.79) or positive (SHR 3.10, 95%CI 1.36-7.07); stage II (SHR 3.20, 95%CI 1.56-6.57) or stage III (SHR 7.41, 95%CI 3.48-15.73). ET use increased significantly but differently across countries from 51-85% in 1996-1998 to 86-96% in 2009-2013.
ER-positive BC patients in Europe are increasingly prescribed ET but between-country disparities persist. Older women and women with severe comorbidity less frequently receive ET. ET omission and severe comorbidity independently predict early disease relapse.
内分泌治疗（ET）是 ER 阳性乳腺癌（BC）的主流辅助治疗方法。我们分析了 2009-2013 年在 9 个欧洲国家诊断的 9293 例 ER 阳性 BC 患者，以研究诊断时的合并症、年龄、分期和亚型如何随时间影响 ET 的使用和复发。
使用逻辑回归根据 Charlson 合并症、年龄、分期和亚型估计接受 ET 的调整比值比（OR）和 95%置信区间（95%CI）。使用竞争风险分析估计 2 年累积复发率和调整后的亚危险比（SHR），以全因死亡为竞争事件。使用 z 检验评估 1996-1998 年和 2009-2013 年接受 ET 的患者比例的差异。
90%的患者开始接受辅助 ET，范围为 96%（比利时、爱沙尼亚、斯洛文尼亚、西班牙）-75%（瑞士）。年龄>75 岁、有严重合并症或 luminal B HER2 阳性癌症的女性开始 ET 的 OR 较低。增加复发风险的独立因素包括：未接受 ET（SHR 2.26，95%CI 1.02-5.03）；严重合并症（SHR 1.94，95%CI 1.06-3.55）；luminal B，无论 HER2 阴性（SHR 3.06，95%CI 1.61-5.79）还是阳性（SHR 3.10，95%CI 1.36-7.07）；II 期（SHR 3.20，95%CI 1.56-6.57）或 III 期（SHR 7.41，95%CI 3.48-15.73）。1996-1998 年，欧洲 ER 阳性 BC 患者接受 ET 的比例从 51%-85%显著增加，但各国之间仍存在差异；年龄较大的女性和合并症严重的女性较少接受 ET。ET 遗漏和严重合并症独立预测早期疾病复发。
