Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
Cancer Epidemiol Biomarkers Prev. 2023 Dec 1;32(12):1683-1689. doi: 10.1158/1055-9965.EPI-23-0544.
To estimate risk of recurrence for women diagnosed with nonmetastatic breast cancer considering the risks of other causes mortality.
We extend a method based on the diagnosis-metastasis-death pathway to include risks of other causes mortality. We estimate three probabilities as cumulative incidence of: (i) being alive and recurrence-free, (ii) death for other causes before a recurrence, and (iii) recurrence. We apply the method to female breast cancer relative survival from the Surveillance, Epidemiology, and End Results Program registries (2000-2018) data.
The cumulative incidence of recurrence shows a higher increase with more advanced cancer stage and is less influenced by age at diagnosis. At 5 years from diagnosis, the cumulative incidence of recurrence is less than 3% for those diagnosed with stage I, 10% to 13% for those diagnosed with stage II, and 37% to 47% for those diagnosed with stage III breast cancer. The estimates of recurrence considering versus ignoring the risks of dying from other causes were generally consistent, except for older women with more advanced stage, and longer time since diagnosis. In these groups, the net probability of recurrence, excluding the risks of dying from other causes, were overestimated.
For patients with cancer who are older or long-term survivors, it is important to include the risks of other cause mortality as the crude cumulative incidence of recurrence is a more appropriate measure.
These estimates are important in clinical decision making, as higher competing mortality may preclude the benefits of aggressive treatments.
为了考虑其他原因导致死亡的风险，估计被诊断为非转移性乳腺癌的女性的复发风险。
我们扩展了一种基于诊断-转移-死亡途径的方法，包括其他原因导致死亡的风险。我们估计了三种概率，即：（i）存活且无复发，（ii）在复发前因其他原因死亡，（iii）复发。我们将该方法应用于监测、流行病学和结果计划登记处（2000-2018 年）数据的女性乳腺癌相对生存率。
复发的累积发生率随着癌症分期的进展而增加得更高，并且受诊断时年龄的影响较小。在诊断后 5 年，诊断为 I 期的患者复发的累积发生率低于 3%，诊断为 II 期的患者为 10%至 13%，诊断为 III 期乳腺癌的患者为 37%至 47%。考虑与不考虑因其他原因死亡的风险的复发估计通常是一致的，除了年龄较大和诊断后时间较长的较晚期女性。在这些群体中，排除因其他原因死亡的风险后的净复发概率被高估了。
对于年龄较大或长期幸存者的癌症患者，重要的是要包括其他原因导致死亡的风险，因为原始累积复发率是更合适的衡量标准。
这些估计对于临床决策制定很重要，因为更高的竞争死亡率可能会排除积极治疗的益处。
