Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Duke Cancer Institute, Durham, NC, USA.
Ann Surg Oncol. 2021 Nov;28(12):7441-7449. doi: 10.1245/s10434-021-10227-3. Epub 2021 May 28.
Although metastatic breast cancer (MBC) remains incurable, advances in therapies have improved survival. Using a contemporary dataset of de novo MBC patients, we explore how overall (OS) and cancer-specific survival (CSS) changed over time.
All patients with de novo MBC from 1988 to 2016 were selected from Surveillance, Epidemiology, and End Results (SEER) 18. Unadjusted OS and CSS were estimated by Kaplan-Meier method and stratified by disease characteristics. Cox proportional hazards models determined factors associated with survival.
47,034 patients were included, with median OS of 25 months and CSS of 27 months. Survival steadily improved over time (1988: 1-year OS 62%, CSS 65%; 2015: 1-year OS 72%, CSS 74%). Patients with triple-negative breast cancer (TNBC) had the worst prognosis and were most likely to die from MBC [versus human epidermal growth factor receptor 2 (HER2)+ and hormone receptor (HR)+/HER2-]. Those with ≥ 4 sites of metastatic disease were also more likely to die from MBC with nearly identical OS and CSS (5-year OS 9%, CSS 9%), when compared with those with 1 site (5-year OS 31%, CSS 35%). After adjustment, improved CSS was associated with bone-only disease [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.83-0.94], while TNBC (versus HER2+: HR 3.12, 95% CI 2.89-3.36) and > 3 sites of metastatic disease (versus 1 site: HR 3.24, 95% CI 2.68-3.91) were associated with worse CSS (all p < 0.001).
Accurate prognostic estimates are essential for patient care. As treatments for patients with MBC have expanded, OS and CSS have improved, and more patients, particularly with limited distant disease or favorable tumor subtypes, are also dying from non-MBC causes.
尽管转移性乳腺癌（MBC）仍然无法治愈，但治疗方法的进步提高了生存率。我们使用当代初诊 MBC 患者数据集，探讨总生存期（OS）和癌症特异性生存期（CSS）随时间的变化。
从监测、流行病学和最终结果（SEER）18 中选择所有初诊 MBC 患者。Kaplan-Meier 法估计未经调整的 OS 和 CSS，并按疾病特征分层。Cox 比例风险模型确定与生存相关的因素。
共纳入 47034 例患者，中位 OS 为 25 个月，CSS 为 27 个月。生存随时间稳步改善（1988 年：1 年 OS 为 62%，CSS 为 65%；2015 年：1 年 OS 为 72%，CSS 为 74%）。三阴性乳腺癌（TNBC）患者预后最差，最有可能死于 MBC[与人类表皮生长因子受体 2（HER2）+和激素受体（HR）+/HER2-相比]。转移性疾病≥4 部位的患者也更有可能死于 MBC，其 OS 和 CSS 几乎相同（5 年 OS 为 9%，CSS 为 9%），而 1 部位患者的 5 年 OS 为 31%，CSS 为 35%）。调整后，CSS 改善与仅骨疾病相关[风险比（HR）0.88，95%置信区间（CI）0.83-0.94]，而 TNBC（与 HER2+相比：HR 3.12，95%CI 2.89-3.36）和>3 个转移部位（与 1 个部位相比：HR 3.24，95%CI 2.68-3.91）与 CSS 较差相关（均 p<0.001）。
准确的预后估计对患者护理至关重要。随着 MBC 患者治疗的扩展，OS 和 CSS 得到了改善，更多的患者，特别是远处疾病有限或肿瘤亚型有利的患者，也死于非 MBC 原因。
