MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK.
Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.
Eur J Cancer. 2022 Sep;173:113-122. doi: 10.1016/j.ejca.2022.06.048. Epub 2022 Jul 19.
There remains a considerable concern among both patients and oncologists that having a live birth (LB) after breast cancer might adversely impact survival.
analysis of survival in a national cohort of women with breast cancer diagnosed at age 20-39 years between 1981 and 2017 (n = 5181), and subsequent LB using Scottish Cancer Registry and national maternity records. Cases had at least one subsequent LB, each was matched with up to six unexposed cases without subsequent LB, accounting for guaranteed time bias.
In 290 women with a LB after diagnosis, overall survival was increased compared to those who did not have a subsequent LB, HR 0.65 (95%CI 0.50-0.85). Women with subsequent LB who had not had a pregnancy before breast cancer showed increased survival (HR 0.56, 0.38-0.82). There was a progressively greater interaction of subsequent LB with survival with younger age, thus for women aged 20-25 years, HR 0.30 (0.12-0.74) vs. those aged 36-39, HR 0.89 (0.42-1.87). In women with LB within five years of diagnosis, survival was also increased (HR 0.66; 0.49-0.89). Survival following LB was similar to unexposed women by ER status (both positive and negative) and in those known to have been exposed to chemotherapy.
This analysis provides further evidence that for the growing number of women who wish to have children after breast cancer, LB does not have a negative impact on overall survival. This finding was confirmed within subgroups, including the youngest women and those not previously pregnant.
患者和肿瘤医生仍然非常担心，乳腺癌患者生育活产儿（LB）可能会对生存产生不利影响。
分析了 1981 年至 2017 年间诊断为 20-39 岁乳腺癌的女性队列中 5181 名患者的生存情况，以及随后通过苏格兰癌症登记处和国家产妇记录的 LB。每个病例都至少有一次后续 LB，并与最多 6 名没有后续 LB 的未暴露病例相匹配，以考虑到保证时间偏差。
在 290 名诊断后有 LB 的女性中，总生存时间与没有后续 LB 的女性相比有所增加，HR 0.65（95%CI 0.50-0.85）。在乳腺癌之前没有怀孕的有后续 LB 的女性生存时间增加（HR 0.56，0.38-0.82）。随后 LB 与生存的交互作用随着年龄的增长而逐渐增加，因此对于 20-25 岁的女性，HR 0.30（0.12-0.74）与 36-39 岁的女性相比，HR 0.89（0.42-1.87）。在诊断后五年内有 LB 的女性，生存时间也有所增加（HR 0.66；0.49-0.89）。LB 后的生存情况与 ER 状态（阳性和阴性）以及已知接受过化疗的未暴露女性相似。
本分析进一步提供了证据，表明对于越来越多希望在乳腺癌后生育的女性，LB 不会对总体生存产生负面影响。这一发现在包括最年轻的女性和那些之前没有怀孕的女性在内的亚组中得到了证实。
