Bruera Sebastian, Lei Xiudong, Pundole Xerxes, Zhao Hui, Giordano Sharon H, Vinod Surabhi, Suarez-Almazor Maria E
Baylor College of Medicine, Houston, Texas.
The University of Texas MD Anderson Cancer Center, Houston.
Arthritis Care Res (Hoboken). 2023 Mar;75(3):559-568. doi: 10.1002/acr.24793. Epub 2022 Nov 26.
Patients with cancer and systemic lupus erythematosus (SLE) may have worse outcomes than those without SLE, given their comorbidities. We examined survival in elderly women with breast cancer (BC) and SLE and hypothesized that survival would be decreased compared with women with BC but without SLE.
We identified patients with BC and SLE and patients with BC without SLE in the Texas Cancer Registry and Surveillance, Epidemiology, and End Results, linked to Medicare claims. Overall survival (OS) was estimated after matching (age and cancer stage) and in multivariable Cox proportional hazards models adjusting for other cancer characteristics, treatment, and comorbidities. Two additional cohorts of women without cancer with and without SLE were also studied.
We identified 494 BC SLE cases and 145,517 BC non-SLE cases, of whom we matched 9,708. Women with SLE were less likely to receive radiation, breast conserving surgery, or endocrine therapy. The 8-year OS estimate for women with early BC (stages 0-II) with and without SLE was 52% (95% confidence interval [95% CI] 45%-59%) and 74% (95% CI 73%-75%), respectively. In the Cox multivariable model, BC and SLE had increased risk of death (hazard ratio [HR] 1.65, 95% CI 1.38-1.98). Women with BC and SLE also had increased risk of death compared with women with SLE but without cancer (HR 1.42, 95% CI 1.05-1.92) after adjusting for SLE severity. Women with SLE and BC received less glucocorticoids, antimalarials, and immunosuppressants after cancer diagnosis than those without cancer.
Systemic lupus is a risk factor for increased mortality in women with early BC.
鉴于癌症患者合并系统性红斑狼疮（SLE），其预后可能比未患SLE的患者更差。我们研究了老年乳腺癌（BC）合并SLE患者的生存率，并假设与单纯患BC但未患SLE的女性相比，前者生存率会降低。
我们在德克萨斯癌症登记处以及监测、流行病学和最终结果数据库中识别出患BC合并SLE的患者以及患BC但未患SLE的患者，并将其与医疗保险理赔记录相链接。在进行匹配（年龄和癌症分期）后，并在多变量Cox比例风险模型中对其他癌症特征、治疗和合并症进行调整后，估计总生存期（OS）。另外还研究了两组分别患有和未患SLE的无癌症女性队列。
我们识别出494例BC合并SLE病例和145,517例BC未合并SLE病例，其中匹配了9,708例。患有SLE的女性接受放疗、保乳手术或内分泌治疗的可能性较小。早期BC（0-II期）合并和未合并SLE的女性8年OS估计值分别为52%（95%置信区间[95%CI]45%-59%）和74%（95%CI 73%-75%）。在Cox多变量模型中，BC合并SLE患者的死亡风险增加（风险比[HR]1.65，95%CI 1.38-1.98）。在对SLE严重程度进行调整后，与患有SLE但未患癌症的女性相比，BC合并SLE的女性死亡风险也增加（HR 1.42，95%CI 1.05-1.92）。与未患癌症的女性相比，癌症诊断后，BC合并SLE的女性接受的糖皮质激素、抗疟药和免疫抑制剂较少。
系统性红斑狼疮是早期BC女性死亡率增加的一个危险因素。
