Matheka Mwongeli, Mutebi Miriam, Sayed Shahin, Shah Jasmit, Shaikh Asim Jamal
Aga Khan University Hospital Nairobi, PO Box 30270 - 00100, Nairobi, Kenya.
Department of Medicine, Aga Khan University, PO Box 30270 - 00100, Nairobi, Kenya.
Ecancermedicalscience. 2023 Jun 27;17:1566. doi: 10.3332/ecancer.2023.1566. eCollection 2023.
There has been an increase in breast cancer in Africa with up to 77% of patients diagnosed with advanced disease. However, there is little data on survival outcomes and prognostic factors affecting survival in patients with metastatic breast cancer (MBC) in Africa. The study objective was to establish the survival of patients with MBC at a single tertiary health facility, the clinical and pathological characteristics affecting survival and describe the treatment modalities used. This was a retrospective descriptive study conducted at Aga Khan University Hospital, Nairobi of patients diagnosed with MBC between 2009 and 2017. Survival data was collected on metastatic free survival, survival time between diagnosis of first metastasis and death and overall survival. Data on patient's age, menopausal status and stage at diagnosis, tumour grade, receptor status, site of metastasis and treatment given was also collected. The Kaplan-Meier Estimator was used to estimate survival. Prognostic factors for survival outcomes were analysed using univariate analysis. Standard descriptive statistics were used to describe patient characteristics. A total of 131 patients were included in the study. The median survival was 22 months. The 3 and 5-year survivals were 31.3% and 10.7%, respectively. On univariate analysis, the Luminal A molecular subtype was a significant positive prognostic factor hazard ratios (HR 0.652 95% confidence interval (CI) 0.473-0.899) while metastasis to the liver or brain were significant negative prognostic factors (HR 0.615 95% CI 0.413-0.915 and HR 0.566 95% CI 0.330-0.973, respectively). A large proportion (87.0%) received some treatment for metastatic disease. Our study concluded that survival rates for patients diagnosed with MBC were lower compared to studies from Western countries but higher than in studies from Sub-Saharan Africa. Luminal A molecular subtype was found to be a positive prognostic factor and metastasis to the liver or brain were found to be negative prognostic factors. Improved access to adequate treatment for MBC is required in the region.
非洲的乳腺癌发病率有所上升，高达77%的患者被诊断为晚期疾病。然而，关于非洲转移性乳腺癌（MBC）患者的生存结果及影响生存的预后因素的数据却很少。本研究的目的是确定一家三级医疗机构中MBC患者的生存率、影响生存的临床和病理特征，并描述所采用的治疗方式。这是一项回顾性描述性研究，在内罗毕的阿迦汗大学医院对2009年至2017年间被诊断为MBC的患者进行。收集了无转移生存期、首次转移诊断至死亡的生存时间和总生存期的生存数据。还收集了患者的年龄、绝经状态、诊断时的分期、肿瘤分级、受体状态、转移部位和所接受治疗的数据。采用Kaplan-Meier估计法来估计生存率。使用单因素分析来分析生存结果的预后因素。采用标准描述性统计来描述患者特征。共有131名患者纳入本研究。中位生存期为22个月。3年和5年生存率分别为31.3%和10.7%。单因素分析显示，Luminal A分子亚型是显著的阳性预后因素（风险比[HR]0.652，95%置信区间[CI]0.473 - 0.899），而肝或脑转移是显著的阴性预后因素（HR分别为0.615，95%CI 0.413 - 0.915和HR 0.566，95%CI 0.330 - 0.973）。很大一部分（87.0%）患者接受了转移性疾病的某种治疗。我们的研究得出结论，与西方国家的研究相比，被诊断为MBC的患者生存率较低，但高于撒哈拉以南非洲地区的研究。发现Luminal A分子亚型是阳性预后因素，而肝或脑转移是阴性预后因素。该地区需要改善MBC患者获得充分治疗的机会。
