乳腺癌患者妊娠或辅助生殖技术后的生存结局：一项基于人群的研究。
Survival outcomes following pregnancy or assisted reproductive technologies after breast cancer: A population-based study.
机构信息
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
出版信息
Cancer. 2022 Sep 1;128(17):3243-3253. doi: 10.1002/cncr.34371. Epub 2022 Jun 29.
BACKGROUND
This study sought to determine the impact of pregnancy or assisted reproductive technologies (ART) on breast-cancer-specific survival among breast cancer survivors.
METHODS
The authors performed a cohort study using a novel data linkage from the California Cancer Registry, the California birth cohort, and the Society for Assisted Reproductive Technology Clinic Outcome Reporting System data sets. They performed risk-set matching in women with stages I-III breast cancer diagnosed between 2000 and 2012. For each pregnant woman, comparable women who were not pregnant at that point but were otherwise similar based on observed characteristics were matched at the time of pregnancy. After matching, Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of pregnancy with breast-cancer-specific survival. We repeated these analyses for women who received ART.
RESULTS
Among 30,021 women with breast cancer, 553 had a pregnancy and 189 attempted at least one cycle of ART. In Cox proportional hazards modeling, the pregnancy group had a higher 5-year disease-specific survival rate; 95.6% in the pregnancy group and 90.6% in the nonpregnant group (HR, 0.43; 95% CI, 0.24-0.77). In women with hormone receptor-positive cancer, we found similar results (HR, 0.43; 95% CI, 0.2-0.91). In the ART analysis, there was no difference in survival between groups; the 5-year disease-specific survival rate was 96.9% in the ART group and 94.1% in the non-ART group (HR, 0.44; 95% CI, 0.17-1.13).
CONCLUSION
Pregnancy and ART are not associated with worse survival in women with breast cancer.
LAY SUMMARY
We sought to determine the impact of pregnancy or assisted reproductive technologies (ART) among breast cancer survivors. We performed a study of 30,021 women by linking available data from California and the Society for Assisted Reproductive Technology Clinic Outcome Reporting System. For each pregnant woman, we matched at the time of pregnancy comparable women who were not pregnant at that point but were otherwise similar based on observed characteristics. We repeated these analyses for women who received ART. We found that pregnancy and ART were not associated with worse survival.
背景
本研究旨在确定妊娠或辅助生殖技术（ART）对乳腺癌幸存者乳腺癌特异性生存的影响。
方法
作者使用加利福尼亚癌症登记处、加利福尼亚出生队列和辅助生殖技术诊所结果报告系统数据集之间的新型数据链接进行了队列研究。他们在 2000 年至 2012 年间诊断为 I-III 期乳腺癌的女性中进行了风险集匹配。对于每一位孕妇，在该时点未怀孕但基于观察到的特征在其他方面相似的可比女性在怀孕时进行匹配。匹配后，使用 Cox 比例风险模型估计妊娠与乳腺癌特异性生存之间的关联的风险比（HR）和 95%置信区间（CI）。我们对接受 ART 的女性重复了这些分析。
结果
在 30021 名患有乳腺癌的女性中，有 553 人怀孕，189 人至少尝试了一个周期的 ART。在 Cox 比例风险模型中，妊娠组的 5 年疾病特异性生存率较高；妊娠组为 95.6%，未妊娠组为 90.6%（HR，0.43；95%CI，0.24-0.77）。在激素受体阳性癌症的女性中，我们发现了类似的结果（HR，0.43；95%CI，0.2-0.91）。在 ART 分析中，两组之间的生存率没有差异；ART 组的 5 年疾病特异性生存率为 96.9%，非 ART 组为 94.1%（HR，0.44；95%CI，0.17-1.13）。
结论
妊娠和 ART 与乳腺癌女性的生存状况无不良关联。
大众摘要
我们试图确定妊娠或辅助生殖技术（ART）对乳腺癌幸存者的影响。我们通过将加利福尼亚州和辅助生殖技术诊所结果报告系统的可用数据进行链接，对 30021 名女性进行了一项研究。对于每一位孕妇，我们在怀孕时匹配了在该时点未怀孕但基于观察到的特征在其他方面相似的可比女性。我们对接受 ART 的女性重复了这些分析。我们发现妊娠和 ART 与生存状况无不良关联。
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