Mancini Silvia, Bucchi Lauro, Biggeri Annibale, Giuliani Orietta, Baldacchini Flavia, Ravaioli Alessandra, Zamagni Federica, Falcini Fabio, Vattiato Rosa
Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy.
Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy.
Breast. 2025 Apr;80:103883. doi: 10.1016/j.breast.2025.103883. Epub 2025 Jan 16.
We report a population-based, competing risk-adjusted analysis of the risk and timing of true recurrences and second primaries in women with breast cancer (BC), that are still ill-defined.
We performed a manual review of medical charts of 1988 BC patients from a cancer registry in northern Italy (2000-2013). The occurrence and timing of true recurrences (TRs, including local, regional and distant recurrences) and second BCs (SBCs, including ipsilateral and contralateral SBC) during 10 years of follow-up were evaluated. The prognostic factors for TRs and SBCs were identified using the Fine and Gray model.
The cumulative incidence was 13.7 % (95 % confidence interval (CI), 12.2-15.3 %) for TRs and 4.6 % (95 % CI, 3.7-5.7 %) for SBCs. The median time to detection varied between 3.4 (TRs) and 5.1 (SBCs) years. The risk of TRs had two peaks, one between the 2nd and the 3rd year of follow-up and another between the 7th and the 8th year. The subhazard of SBCs fluctuated for five years, had a drop between the 6th and the 7th year and a marked peak between the 8th and the 9th year. Prognostic factors for TRs (tumour stage and grade, lymph node status and residual disease) and SBCs (patient age and -inverse association- hormone therapy) were different. In the 9th-10th year of follow-up, the excess incidence of total BC episodes as compared with the expected incidence of BC was no longer significant (standardised incidence ratio, 1.15; 95 % CI, 0.86-1.53).
The multifaceted results of this study warrant further research into the risk and timing of all types of BC recurrence.
我们报告了一项基于人群的、经竞争风险调整的分析，该分析针对乳腺癌（BC）女性患者真正复发和第二原发性肿瘤的风险及时间，这些方面仍定义不明确。
我们对意大利北部一个癌症登记处的1988例BC患者的病历进行了人工审查。评估了随访10年间真正复发（TR，包括局部、区域和远处复发）和第二原发性乳腺癌（SBC，包括同侧和对侧SBC）的发生情况及时间。使用Fine和Gray模型确定TR和SBC的预后因素。
TR的累积发病率为13.7%（95%置信区间（CI），12.2 - 15.3%），SBC的累积发病率为4.6%（95%CI，3.7 - 5.7%）。检测到复发的中位时间在3.4年（TR）和5.1年（SBC）之间。TR的风险有两个高峰，一个在随访的第2年至第3年之间，另一个在第7年至第8年之间。SBC的亚风险率波动了五年，在第6年至第7年有所下降，在第8年至第9年有一个明显的高峰。TR（肿瘤分期和分级、淋巴结状态及残留疾病）和SBC（患者年龄以及与激素治疗呈负相关）的预后因素不同。在随访的第9年至第10年，与BC的预期发病率相比，BC总发作的超额发病率不再显著（标准化发病率比，1.15；95%CI，0.86 - 1.53）。
本研究的多方面结果值得对所有类型BC复发的风险和时间进行进一步研究。
