The Ohio State University College of Medicine, Columbus, OH, USA.
Edinburgh Clinical Trials Unit, The Usher Institute, The University of Edinburgh, Edinburgh, EH16 4UX, UK.
Breast Cancer Res. 2023 Oct 3;25(1):106. doi: 10.1186/s13058-023-01704-6.
Women from socioeconomically deprived areas have lower breast cancer (BC) incidence rates for screen-detected oestrogen receptor (ER) + tumours and higher mortality for select tumour subtypes. We aimed to determine if ipsilateral breast cancer recurrence (IBR) differs by Scottish Index of Multiple Deprivation (SIMD) quintile and tumour subtype in Scotland.
Patient data for primary invasive BC diagnosed in 2007-2008 in Scotland was analysed. Manual case-note review for 3495 patients from 10 years post-diagnosis was used. To determine the probability of IBR while accounting for the competing risk of death from any cause, cumulative incidence functions stratified by ER subtype and surgery were plotted. Multivariable Cox Proportional Hazards models were used to estimate the association of SIMD accounting for other predictors of IBR.
Among 2819 ER + tumours, 423 patients had a recurrence and 438 died. SIMD was related to death (p = 0.018) with the most deprived more likely to have died in the 10-year period (17.7% vs. 12.9%). We found no significant differences by SIMD in prognostic tumour characteristics (grade, TNM stage, treatment, screen-detection) or risk of IBR. Among 676 patients diagnosed with ER- tumours, 105 died and 185 had a recurrence. We found no significant differences in prognostic tumour characteristics by SIMD except screen detection with the most deprived more likely than the least to have their tumours detected from screening (46.9% vs. 28%, p = 0.03). Among patients with ER- tumours, 50% had mastectomy and the most deprived had increased 5-year IBR risk compared to the least deprived (HR 3.03 [1.41-6.53]).
IBR is not a major contributor to mortality differences by SIMD for the majority of BC patients in our study. The lack of inequities in IBR are likely due to standardised treatment protocols and access to healthcare. The association with socioeconomic deprivation and recurrence for ER- tumours requires further study.
来自社会经济贫困地区的女性，其雌激素受体（ER）阳性肿瘤的乳腺癌（BC）发病率较低，而某些肿瘤亚型的死亡率较高。我们旨在确定苏格兰的社会经济剥夺指数（SIMD）五分位数和肿瘤亚型是否会影响同侧乳腺癌复发（IBR）。
分析了 2007-2008 年在苏格兰诊断的原发性浸润性 BC 患者的数据。对 10 年后诊断的 3495 例患者进行了手动病历回顾。为了确定IBR 的概率，同时考虑到任何原因导致的死亡的竞争风险，绘制了按 ER 亚型和手术分层的累积发生率函数。使用多变量 Cox 比例风险模型来估计 SIMD 与 IBR 其他预测因素的关联。
在 2819 例 ER 阳性肿瘤中，423 例患者出现复发，438 例患者死亡。SIMD 与死亡相关（p=0.018），最贫困的人群在 10 年内死亡的可能性更高（17.7%比 12.9%）。我们没有发现 SIMD 与预后肿瘤特征（分级、TNM 分期、治疗、筛查检测）或 IBR 风险之间存在显著差异。在 676 例 ER 阴性肿瘤患者中，105 例死亡，185 例复发。我们没有发现 SIMD 与预后肿瘤特征之间存在显著差异，除了筛查检测，最贫困的人群比最不贫困的人群更有可能通过筛查发现肿瘤（46.9%比 28%，p=0.03）。在 ER 阴性肿瘤患者中，50%行乳房切除术，最贫困的人群比最不贫困的人群 5 年 IBR 风险更高（HR 3.03[1.41-6.53]）。
在我们的研究中，对于大多数 BC 患者，IBR 并不是 SIMD 导致死亡率差异的主要原因。缺乏与社会经济贫困相关的 IBR 可能是由于标准化的治疗方案和获得医疗保健的机会。与 ER 阴性肿瘤相关的社会经济贫困与复发之间的关联需要进一步研究。
