Chen Heyan, Yan Lutong, Pu Shengyu, Zhu Lizhe, Zhang Huimin, Zhou Can
Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
J Oncol. 2021 Sep 17;2021:9988624. doi: 10.1155/2021/9988624. eCollection 2021.
Knowledge of the effect of prior cancer on long-term survival outcomes for patients with nonmetastatic triple-negative breast cancer (TNBC) remained unclear. The aim of this study was to explore and identify the effectiveness of prior cancer on breast cancer-specific death (BCSD) and other cause-specific death (OCSD) in patients with nonmetastatic TNBC.
Data of 29,594 participants with nonmetastatic TNBC patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2016. Prognostic predictors were identified by propensity score matching (PSM) analysis combined with univariate cumulative incidence function (CIF) and multivariate Fine and Gray competitive risk analyses.
Among the women with nonmetastatic TNBC included in the unmatched cohort, a total of 5,375 (18.2%) subjects had prior cancers (P-TNBC) and 24,219 (81.8%) had no prior cancer (NP-TNBC). Patients with P-TNBC tended to have poorer BCSD (Gray's test, =0.0131) and OCSD (Gray's test, =0.0009) in comparison with those with NP-TNBC after PSM. However, the risk of BCSD (=0.291) and OCSD (=0.084) found no difference among P-TNBC patients with one prior cancer and two or more prior cancers after PSM. Additionally, subjects with younger age, advanced T stage, advanced N stage, and advanced differentiation grade tumors were likely to develop BCSD, whereas those with breast-conserving surgery (BCS), radiotherapy, or chemotherapy tended to have a lower incidence of BCSD.
Our study demonstrated that prior cancer was related to the worse BCSD and OCSD rate and could be identified as a reliable survival predictor for patients with nonmetastatic TNBC. This study may provide some reference value for the treatment mode of TNBC patients with prior cancer in the future.
既往癌症对非转移性三阴性乳腺癌（TNBC）患者长期生存结局的影响尚不清楚。本研究的目的是探讨并确定既往癌症对非转移性TNBC患者乳腺癌特异性死亡（BCSD）和其他原因特异性死亡（OCSD）的影响。
从2010年至2016年的监测、流行病学和最终结果（SEER）数据库中提取了29594例非转移性TNBC患者的数据。通过倾向评分匹配（PSM）分析结合单变量累积发病率函数（CIF）和多变量Fine和Gray竞争风险分析来确定预后预测因素。
在未匹配队列中纳入的非转移性TNBC女性中，共有5375例（18.2%）受试者有既往癌症（P-TNBC），24219例（81.8%）无既往癌症（NP-TNBC）。PSM后，与NP-TNBC患者相比，P-TNBC患者的BCSD（Gray检验，=0.0131）和OCSD（Gray检验，=0.0009）倾向于更差。然而，PSM后，在有一次既往癌症的P-TNBC患者和有两次或更多次既往癌症的P-TNBC患者之间，BCSD（=0.291）和OCSD（=0.084）的风险没有差异。此外，年龄较小、T分期较晚、N分期较晚和肿瘤分化程度较高的受试者可能发生BCSD，而接受保乳手术（BCS）、放疗或化疗的受试者BCSD发生率往往较低。
我们的研究表明，既往癌症与更差的BCSD和OCSD率相关，并且可以被确定为非转移性TNBC患者的可靠生存预测因素。本研究可能为未来有既往癌症的TNBC患者的治疗模式提供一些参考价值。
