乳腺癌患者的多种合并症与总生存：来自南非乳腺癌和 HIV 结局研究的结果。
Multimorbidity and overall survival among women with breast cancer: results from the South African Breast Cancer and HIV Outcomes Study.
机构信息
Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Radiation Oncology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
出版信息
Breast Cancer Res. 2023 Jan 23;25(1):7. doi: 10.1186/s13058-023-01603-w.
BACKGROUND
Breast cancer survival in South Africa is low, but when diagnosed with breast cancer, many women in South Africa also have other chronic conditions. We investigated the impact of multimorbidity (≥ 2 other chronic conditions) on overall survival among women with breast cancer in South Africa.
METHODS
Between 1 July 2015 and 31 December 2019, we enrolled women newly diagnosed with breast cancer at six public hospitals participating in the South African Breast Cancer and HIV Outcomes (SABCHO) Study. We examined seven chronic conditions (obesity, hypertension, diabetes, HIV, cerebrovascular diseases (CVD), asthma/chronic obstructive pulmonary disease, and tuberculosis), and we compared socio-demographic, clinical, and treatment factors between patients with and without each condition, and with and without multimorbidity. We investigated the association of multimorbidity with overall survival using multivariable Cox proportional hazard models.
RESULTS
Of 3,261 women included in the analysis, 45% had multimorbidity; obesity (53%), hypertension (41%), HIV (22%), and diabetes (13%) were the most common individual conditions. Women with multimorbidity had poorer overall survival at 3 years than women without multimorbidity in both the full cohort (60.8% vs. 64.3%, p = 0.036) and stage groups: stages I-II, 80.7% vs. 86.3% (p = 0.005), and stage III, 53.0% vs. 59.4% (p = 0.024). In an adjusted model, women with diabetes (hazard ratio (HR) = 1.20, 95% confidence interval (CI) = 1.03-1.41), CVD (HR = 1.43, 95% CI = 1.17-1.76), HIV (HR = 1.21, 95% CI = 1.06-1.38), obesity + HIV (HR = 1.24 95% CI = 1.04-1.48), and multimorbidity (HR = 1.26, 95% CI = 1.13-1.40) had poorer overall survival than women without these conditions.
CONCLUSIONS
Irrespective of the stage, multimorbidity at breast cancer diagnosis was an important prognostic factor for survival in our SABCHO cohort. The high prevalence of multimorbidity in our cohort calls for more comprehensive care to improve outcomes for South African women with breast cancer.
背景
南非的乳腺癌存活率较低，但南非许多女性在被诊断出患有乳腺癌时，也患有其他慢性疾病。我们研究了多疾病（≥2 种其他慢性疾病）对南非乳腺癌患者总生存率的影响。
方法
在 2015 年 7 月 1 日至 2019 年 12 月 31 日期间，我们招募了在参与南非乳腺癌和艾滋病毒结局（SABCHO）研究的六家公立医院新诊断为乳腺癌的女性。我们检查了七种慢性疾病（肥胖、高血压、糖尿病、艾滋病毒、脑血管疾病（CVD）、哮喘/慢性阻塞性肺疾病和结核病），并比较了有和没有每种疾病以及有和没有多疾病的患者的社会人口统计学、临床和治疗因素。我们使用多变量 Cox 比例风险模型研究了多疾病与总生存率的关系。
结果
在纳入分析的 3261 名女性中，45%患有多疾病；肥胖症（53%）、高血压（41%）、艾滋病毒（22%）和糖尿病（13%）是最常见的单一疾病。在全队列（60.8%对 64.3%，p=0.036）和分期组中，患有多疾病的女性与无多疾病的女性相比，3 年总体生存率较低：I 期和 II 期，80.7%对 86.3%（p=0.005），III 期，53.0%对 59.4%（p=0.024）。在调整后的模型中，患有糖尿病的女性（风险比（HR）=1.20，95%置信区间（CI）=1.03-1.41）、CVD（HR=1.43，95%CI=1.17-1.76）、艾滋病毒（HR=1.21，95%CI=1.06-1.38）、肥胖症+艾滋病毒（HR=1.24，95%CI=1.04-1.48）和多疾病（HR=1.26，95%CI=1.13-1.40）的女性总体生存率较差。
结论
无论分期如何，乳腺癌诊断时的多疾病都是本 SABCHO 队列中生存的重要预后因素。我们的队列中多疾病的高患病率呼吁提供更全面的护理，以改善南非乳腺癌女性的结局。
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