Heumann Philipp, Benner Axel, Behrens Sabine, Chang-Claude Jenny, Seibold Petra
Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany.
Breast Cancer Res. 2025 May 12;27(1):76. doi: 10.1186/s13058-025-02036-3.
Cancer-related fatigue (CRF) is a common symptom in breast cancer patients and survivors, which can substantially impair quality of life. Previous studies suggested that CRF may be associated with poorer survival outcomes, but had limited follow-up duration or insufficient adjustment for established prognostic factors. The aim of this analysis was to assess the prognostic value of CRF at the end of radiotherapy for overall survival in a cohort of women with breast cancer with a median follow-up time of 19 years.
Data from the prospective ISE study, which enrolled women with non-metastatic breast cancer between 1998 and 2001, were analysed. Patients did not receive chemotherapy. A vital status follow-up was conducted in 2019. CRF was collected at the end of radiotherapy using the EORTC QLQ-C30 and classified using the threshold of clinical importance. Cox regression models adjusted for CRF, age, body mass index (BMI), tumour size, nodal involvement, grading and receptor status were calculated.
Of 437 patients with fatigue assessments, 164 (38%) reported CRF. During 10 years of follow-up, 25 patients without and 27 patients with CRF died. Tumour size, nodal involvement and age were statistically significantly associated with 10-year overall survival. For CRF, a statistically significant effect was observed for ≥ 5 years of follow-up (HR: 2.44), but not within the first 5 years of follow-up (HR: 1.26).
CRF assessments at the end of radiotherapy showed prognostic value for long-term survival beyond established factors and could potentially be used to identify patients that require monitoring in risk-adapted aftercare programmes in order to improve survival.
癌症相关疲劳（CRF）是乳腺癌患者及其幸存者中常见的症状，会严重损害生活质量。既往研究表明，CRF可能与较差的生存结局相关，但随访时间有限或对既定预后因素的调整不足。本分析的目的是评估放疗结束时CRF对一组中位随访时间为19年的乳腺癌女性患者总生存的预后价值。
分析了前瞻性ISE研究的数据，该研究纳入了1998年至2001年间的非转移性乳腺癌女性患者。患者未接受化疗。2019年进行了生命状态随访。放疗结束时使用欧洲癌症研究与治疗组织QLQ-C30收集CRF，并根据临床重要性阈值进行分类。计算了调整CRF、年龄、体重指数（BMI）、肿瘤大小、淋巴结受累情况、分级和受体状态的Cox回归模型。
在437例进行疲劳评估的患者中，164例（38%）报告有CRF。在10年的随访期间，25例无CRF患者和27例有CRF患者死亡。肿瘤大小、淋巴结受累情况和年龄与10年总生存有统计学显著相关性。对于CRF，在随访≥5年时观察到有统计学显著影响（HR：2.44），但在随访的前5年内未观察到（HR：1.26）。
放疗结束时的CRF评估显示出除既定因素外对长期生存的预后价值，并且有可能用于识别在风险适应性后续护理计划中需要监测的患者，以改善生存。
