Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041 Guangdong, China.
Biomed Res Int. 2022 Sep 2;2022:6116658. doi: 10.1155/2022/6116658. eCollection 2022.
Patients with a previous cancer history (PCA) are routinely excluded from most clinical trials, which may limit the accuracy and universality of clinical trials. We aimed to explore the association between PCA and survival of patients with different molecular subtypes of breast cancer. Patients diagnosed with breast cancer from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015 were included in this retrospective cohort study. The primary outcome was overall survival (OS), which was calculated from date of diagnosis to date of death or censor date during this period. The relationship between PCA and OS of patients with different molecular subtypes of breast cancer was analyzed by the Kaplan-Meier curves and multivariate Cox proportional-hazards model. A total of 35,640 primary breast cancer patients were included, and 2,038 (5.72%) patients had a PCA. Female genital system cancer (491 cases, 24.09%) was the largest proportion type of previous cancer, and HER2-positive (24,754 cases, 69.46%) breast cancer was the most common subtype. Patients with previous female genital/endocrine system cancer history and other cancers history were associated with a poorer OS in overall patients, and in patients with triple-negative and HER2-positive subtypes ( < 0.05). In patients with Luminal A and Luminal B subtypes, previous other cancers history was related to poor OS ( < 0.05), while female genital/endocrine system cancer history may not influence the OS ( > 0.05). Subgroup analyses presented that PCA was related to poor OS in patients aged 40-64 years and ≥65 years ( <0.05), while prognosis in patients aged 18-40 years may not be influenced by PCA ( > 0.05). The impact of PCA on the prognosis of breast cancer patients was related to molecular type, patient age, and type of PCA. In clinical trials of breast cancer, the exclusion criteria for PCA patients may be modified according to the above variables.
患有既往癌症史（PCA）的患者通常被排除在大多数临床试验之外，这可能会限制临床试验的准确性和普遍性。我们旨在探讨 PCA 与不同分子亚型乳腺癌患者生存之间的关系。本回顾性队列研究纳入了 2010 年至 2015 年期间从监测、流行病学和最终结果（SEER）数据库诊断为乳腺癌的患者。主要结局是总生存期（OS），从诊断日期计算到该期间的死亡或删失日期。通过 Kaplan-Meier 曲线和多变量 Cox 比例风险模型分析 PCA 与不同分子亚型乳腺癌患者 OS 的关系。共纳入 35640 例原发性乳腺癌患者，其中 2038 例（5.72%）患者有 PCA。女性生殖系统癌症（491 例，24.09%）是既往癌症中最大的比例类型，HER2 阳性（24754 例，69.46%）乳腺癌是最常见的亚型。既往女性生殖/内分泌系统癌症史和其他癌症史的患者与总体患者的 OS 较差相关，并且与三阴性和 HER2 阳性亚型的患者相关（<0.05）。在 Luminal A 和 Luminal B 亚型的患者中，既往其他癌症史与 OS 较差相关（<0.05），而女性生殖/内分泌系统癌症史可能不会影响 OS（>0.05）。亚组分析表明，PCA 与 40-64 岁和≥65 岁患者的 OS 较差相关（<0.05），而 18-40 岁患者的预后可能不受 PCA 影响（>0.05）。PCA 对乳腺癌患者预后的影响与分子类型、患者年龄和 PCA 类型有关。在乳腺癌临床试验中，可根据上述变量修改 PCA 患者的排除标准。
