美国年龄与乳腺癌脑转移共存和死亡率的关系：被忽视的 SEER 分析。

Association between age and the presence and mortality of breast cancer synchronous brain metastases in the United States: A neglected SEER analysis.

机构信息

Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China.

Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.

出版信息

Front Public Health. 2022 Sep 23;10:1000415. doi: 10.3389/fpubh.2022.1000415. eCollection 2022.

DOI:10.3389/fpubh.2022.1000415

PMID:36211679

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9539918/

Abstract

BACKGROUND

The extent of the relationship between age and the presence of breast cancer synchronous brain metastases (BCSBMs) and mortality has not yet been well-identified or sufficiently quantified. We aimed to examine the association of age with the presence of BCSBMs and all-cause and cancer-specific mortality outcomes using the SEER database.

METHODS

Age-associated risk of the presence and survival of BCSBMs were evaluated on a continuous scale (restricted cubic spline, RCS) with logistic or Cox regression models. The main endpoints were the presence of BCSBMs and all-cause mortality or cancer-specific mortality. Cox proportional hazards regression and competing risk models were used in survival analysis.

RESULTS

Among 374,132 adult breast cancer patients, 1,441 (0.38%) had BMs. The presence of BCSBMs displayed a U-shaped relationship with age, with the highest point of the curve occurring at the age of 62. In both the younger (age ≤ 61) and older (age ≥ 62) groups, the observed curve showed a nearly linear relationship between age and the presence of BCSBMs. The relationship between age and all-cause mortality (ASM) and cancer-specific mortality (CSM) was linear. Older age at diagnosis was associated with a higher risk of ASM (HR 1.019, 95% CI: 1.013-1.024, < 0.001) and CSM (HR 1.016, 95% CI: 1.010-1.023, < 0.001) in multivariable Cox models. Age (sHR 1.007, 95% CI 1-1.013, = 0.049) was substantially related to a significantly increased risk of CSM in competing risk models.

CONCLUSION

Age had a non-linear U-shaped relationship with the presence of BCSBMs and a linear relationship with BCSBMs mortality.

摘要

背景

年龄与乳腺癌合并脑转移（BCSBMs）的存在和死亡率之间的关系尚未得到很好的确定或充分量化。我们旨在使用 SEER 数据库检查年龄与 BCSBMs 的存在以及全因和癌症特异性死亡率结果之间的关联。

方法

使用逻辑或 Cox 回归模型，在连续尺度（限制立方样条，RCS）上评估年龄与 BCSBMs 的存在和生存风险之间的关联。主要终点是 BCSBMs 的存在和全因死亡率或癌症特异性死亡率。Cox 比例风险回归和竞争风险模型用于生存分析。

结果

在 374132 名成年乳腺癌患者中，有 1441 名（0.38%）患有 BMs。BCSBMs 的存在与年龄呈 U 形关系，曲线的最高点出现在 62 岁。在年龄较小（≤61 岁）和年龄较大（≥62 岁）的组中，观察到的曲线显示年龄与 BCSBMs 之间存在近乎线性的关系。年龄与全因死亡率（ASM）和癌症特异性死亡率（CSM）之间的关系呈线性。诊断时年龄较大与 ASM（HR 1.019，95%CI：1.013-1.024，<0.001）和 CSM（HR 1.016，95%CI：1.010-1.023，<0.001）的风险增加相关多变量 Cox 模型。在竞争风险模型中，年龄（sHR 1.007，95%CI 1-1.013，=0.049）与 CSM 的风险显著增加有实质性关系。