Abdul Rahman Hanif, Zaim Siti Nurzaimah Nazhirah, Suhaimei Ummi Salwa, Jamain Al Amin
PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Tungku Link Road, Gadong BE1410, Brunei.
Diseases. 2024 May 23;12(6):111. doi: 10.3390/diseases12060111.
Breast cancer is the fifth-ranked cancer globally. Despite early diagnosis and advances in treatment, breast cancer mortality is increasing. This meta-analysis aims to examine all possible prognostic factors that improve/deteriorate breast cancer-specific survival. MEDLINE, PubMed, ScienceDirect, Ovid, and Google Scholar were systematically searched until September 16, 2023. The retrieved studies from 1995 to 2022 accumulated 1,386,663 cases from 30 countries. A total of 13 out of 22 prognostic factors were significantly associated with breast cancer-specific survival. A random-effects model provided a pooled estimate of the top five poorest prognostic factors, including Stage 4 (HR = 12.12; 95% CI: 5.70, 25.76), followed by Stage 3 (HR = 3.42, 95% CI: 2.51, 4.67), a comorbidity index ≥ 3 (HR = 3.29; 95% CI: 4.52, 7.35), the poor differentiation of cancer cell histology (HR = 2.43; 95% CI: 1.79, 3.30), and undifferentiated cancer cell histology (HR = 2.24; 95% CI: 1.66, 3.01). Other survival-reducing factors include positive nodes, age, race, HER2-receptor positivity, and overweight/obesity. The top five best prognostic factors include different types of mastectomies and breast-conserving therapies (HR = 0.56; 95% CI: 0.44, 0.70), medullary histology (HR = 0.62; 95% CI: 0.53, 0.72), higher education (HR = 0.72; 95% CI: 0.68, 0.77), and a positive estrogen receptor status (HR = 0.78; 95% CI: 0.65, 0.94). Heterogeneity was observed in most studies. Data from developing countries are still scarce.
乳腺癌是全球排名第五的癌症。尽管早期诊断和治疗取得了进展,但乳腺癌死亡率仍在上升。这项荟萃分析旨在研究所有可能改善/恶化乳腺癌特异性生存的预后因素。对MEDLINE、PubMed、ScienceDirect、Ovid和谷歌学术进行了系统检索,直至2023年9月16日。检索到的1995年至2022年的研究共纳入了来自30个国家的1386663例病例。22个预后因素中有13个与乳腺癌特异性生存显著相关。随机效应模型对预后最差的五个因素进行了汇总估计,包括IV期(HR = 12.12;95% CI:5.70,25.76),其次是III期(HR = 3.42,95% CI:2.51,4.67)、合并症指数≥3(HR = 3.29;95% CI:4.52,7.35)、癌细胞组织学低分化(HR = 2.43;95% CI:1.79,3.30)和未分化癌细胞组织学(HR = 2.24;95% CI:1.66,3.01)。其他降低生存的因素包括阳性淋巴结、年龄、种族、HER2受体阳性以及超重/肥胖。预后最好的五个因素包括不同类型的乳房切除术和保乳治疗(HR = 0.56;95% CI:0.44,0.70)、髓样组织学(HR = 0.62;95% CI:0.53,0.72)、高等教育(HR = 0.72;95% CI:0.68,0.77)以及雌激素受体阳性状态(HR = 0.78;95% CI:0.65,0.94)。大多数研究中观察到了异质性。来自发展中国家的数据仍然稀缺。
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