Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
ESMO Open. 2024 Apr;9(4):102972. doi: 10.1016/j.esmoop.2024.102972. Epub 2024 Mar 22.
Evidence suggests that women with breast cancer diagnosed during pregnancy (PrBC) and within 2 years of delivery (PPBC) have similar survival compared to women diagnosed not near pregnancy if adjusted for stage and subtype. To investigate whether this is true for all subtypes and for both pregnancy and post-delivery periods, we examined clinicopathologic features and survival in women with breast cancer by trimesters and 6-month post-delivery intervals.
Women diagnosed with invasive breast cancer during 1992-2018 at ages 18-44 years were identified in the Swedish Cancer Register, with information on childbirths from the Swedish Multi-Generation Register and clinical data from Breast Cancer Quality Registers. Each woman with PrBC or PPBC was matched 1 : 2 by age and year to comparators diagnosed with breast cancer not near pregnancy. Distributions of stage, grade, and surrogate subtypes were compared. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for breast cancer mortality were estimated using Cox regression.
We identified 1430 women with PrBC and PPBC (181 during pregnancy, 499 during the first and 750 during the second year after delivery). Compared to 2860 comparators, women with PrBC and PPBC in the first year after delivery had a significantly higher proportion of luminal human epidermal growth factor receptor 2 (HER2)-positive, HER2-positive and triple-negative tumours, and more advanced stage at diagnosis. After adjustment for age, year, parity, country of birth, hospital region, subtype, and stage, women diagnosed during the second trimester had a worse prognosis than matched comparators (HR 1.8, 95% CI: 1.0-3.2).
Women diagnosed during pregnancy or within the first year after delivery have a worse prognosis than women diagnosed not near pregnancy due to adverse tumour biology and advanced stage at diagnosis. A worse prognosis for women diagnosed during the second trimester remained after multivariable adjustment, possibly reflecting difficulties to provide optimal treatment during ongoing pregnancy.
有证据表明，与妊娠临近时间段诊断的乳腺癌（PrBC）和产后 2 年内诊断的乳腺癌（PPBC）患者相比，如果调整了分期和亚型，这些患者的生存情况与非妊娠临近时间段诊断的乳腺癌患者相似。为了探究这一结论是否适用于所有亚型以及妊娠和产后两个时间段，我们通过 trimester 和产后 6 个月间隔，研究了乳腺癌患者的临床病理特征和生存情况。
1992 年至 2018 年期间，在瑞典癌症登记处确定了年龄在 18-44 岁之间被诊断患有浸润性乳腺癌的女性，通过瑞典多代登记处获得了与妊娠相关的分娩信息，通过乳腺癌质量登记处获得了临床数据。每个 PrBC 或 PPBC 患者都与年龄和年份匹配的非妊娠临近时间段诊断的乳腺癌患者进行 1:2 配对。比较了分期、分级和替代亚型的分布情况。使用 Cox 回归估计了乳腺癌死亡率的调整风险比（HR）和 95%置信区间（CI）。
我们确定了 1430 名 PrBC 和 PPBC 患者（妊娠期间 181 名，产后第一年 499 名，第二年 750 名）。与 2860 名对照组相比，产后第一年诊断的 PrBC 和 PPBC 患者中， luminal 人表皮生长因子受体 2（HER2）阳性、HER2 阳性和三阴性肿瘤的比例以及诊断时的分期明显更高。调整年龄、年份、产次、出生地、医院区域、亚型和分期后，妊娠中期诊断的患者预后比匹配的对照组差（HR 1.8，95%CI：1.0-3.2）。
由于肿瘤生物学不良和诊断时分期较晚，妊娠期间或产后 1 年内诊断的患者预后比非妊娠临近时间段诊断的患者差。多变量调整后，妊娠中期诊断的患者预后较差，这可能反映了在妊娠期间提供最佳治疗存在困难。
