Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
National Cancer Registry Ireland, Cork, Ireland.
Breast Cancer Res. 2024 Nov 27;26(1):171. doi: 10.1186/s13058-024-01881-y.
To assess proportions of metastatic recurrence in women initially diagnosed with non-metastatic breast cancer by stage at diagnosis, breast cancer subtype, calendar period and age.
A systematic search of MEDLINE and Web of Science databases (January 2010-12 May 2022) was conducted. Studies reporting the proportion of distant metastatic recurrence in women with non-metastatic breast cancer were identified and outcomes and characteristics were extracted. Risk of bias was assessed independently by two reviewers. Random-effects meta-analyses of proportions were used to calculate pooled estimates and 95% confidence intervals (CIs).
193 studies covering over 280,000 patients were included in the main analysis. Pooled proportions of metastatic recurrence increased with longer median follow-up time from 12.2% (95% CI 10.5-14.0%) at 1-4 years post diagnosis, 14.3% (95% CI 12.9-15.7%) at 5-9 years to 23.3% (95% CI 20.1-26.8) at 10 years or more. Regional variation was observed with pooled estimates ranging from 11.0% (95% CI 8.5-13.7%) in Europe to 26.4% (95% CI 16.7-37.4%) in Africa (1-4 years follow-up). Proportions of recurrence were higher in studies with diagnosis before 2000 (22.2%, 95% CI 15.1-30.3) compared to studies with diagnosis from 2000 onwards (12.8%, 95% CI 11.7-14.0). At 1-4 years median follow-up, pooled proportions of metastatic recurrence were higher in women with hormone receptor negative (15.2%, 95% CI 12.0-18.7%) compared with receptor positive disease (9.6%, 95% CI 6.2-13.6%) and in women with locally advanced (33.2%, 95% CI 24.7-42.3%) relative to early disease at initial diagnosis (4.8%, 95% CI 2.5-7.8%). Proportions were higher in those under 50 years compared with 70+ years, 18.6% (95% CI 15.9-21.4%) versus 13.3% (95% CI 9.2, 18.0%), respectively. Heterogeneity was high in all meta-analyses and results should be interpreted with caution.
Higher proportions of metastatic recurrence in patients initially diagnosed at an advanced stage and in earlier calendar period emphasises the importance of early detection and treatment advancements. As the global number of breast cancer survivors increases, research and health policy efforts should be directed towards timely diagnosis and access to effective treatments and care.
PROSPERO CRD42022314500.
评估初始诊断为非转移性乳腺癌的女性中按诊断时的分期、乳腺癌亚型、时间区间和年龄划分的远处转移复发比例。
对 MEDLINE 和 Web of Science 数据库进行了系统检索（2010 年 1 月至 2022 年 5 月 12 日）。确定了报告非转移性乳腺癌女性远处转移复发比例的研究，并提取了结局和特征。两名评审员独立评估了偏倚风险。使用随机效应荟萃分析计算了比例的汇总估计值和 95%置信区间（CI）。
主要分析纳入了 193 项涵盖超过 28 万名患者的研究。从诊断后 1-4 年的 12.2%（95%CI 10.5-14.0%）、5-9 年的 14.3%（95%CI 12.9-15.7%）到 10 年或更长时间的 23.3%（95%CI 20.1-26.8%），转移性复发的比例随中位随访时间的延长而增加。观察到区域性差异，欧洲的汇总估计值范围为 11.0%（95%CI 8.5-13.7%），非洲为 26.4%（95%CI 16.7-37.4%）（1-4 年随访）。与 2000 年以后诊断的研究相比，2000 年以前诊断的研究（22.2%，95%CI 15.1-30.3%）中复发比例更高。在 1-4 年的中位随访期间，激素受体阴性（15.2%，95%CI 12.0-18.7%）的女性与受体阳性疾病（9.6%，95%CI 6.2-13.6%）相比，远处转移复发的比例更高，与初始诊断时局部晚期（33.2%，95%CI 24.7-42.3%）相比，早期疾病（4.8%，95%CI 2.5-7.8%）的比例更高。与 70 岁以上的患者相比，50 岁以下的患者比例更高，分别为 18.6%（95%CI 15.9-21.4%）和 13.3%（95%CI 9.2, 18.0%）。所有荟萃分析中的异质性都很高，结果应谨慎解释。
在初始诊断为晚期和较早时期的患者中，远处转移复发的比例较高，这强调了早期发现和治疗进展的重要性。随着全球乳腺癌幸存者人数的增加，研究和卫生政策工作应致力于及时诊断和获得有效的治疗和护理。
PROSPERO CRD42022314500。
