Kroman N, Jensen M B, Melbye M, Wohlfahrt J, Mouridsen H T
Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, Copenhagen, Denmark.
Lancet. 1997 Aug 2;350(9074):319-22. doi: 10.1016/S0140-6736(97)03052-3.
Oestrogen is an established growth factor in breast cancer. There has, therefore, been much discussion about whether women should be advised against becoming pregnant after breast-cancer treatment because of a possible negative prognostic effect from the high oestrogen concentrations associated with pregnancy.
We studied 5725 women with primary breast cancer. Information on these women was obtained from the Danish Breast Cancer Cooperative Group. Since 1977 this group has collected population-based data on tumour characteristics, treatment regimens, and follow-up status of Danish women with breast cancer. Details of reproductive history were obtained from The Danish Civil Registration System, the National Birth Registry, and the National induced Abortion registry. We estimated the relative risk of death among women who became pregnant after breast-cancer treatment compared with women who had not become pregnant.
5725 women with primary breast cancer aged 45 years of younger at the time of diagnosis were followed up for 35,067 patient-years. Among these, 173 women became pregnant after treatment of breast cancer. Women who had a full-term pregnancy after breast-cancer treatment had a non-significantly reduced risk of death (relative risk 0.55 [95% CI 0.28-1.06]) compared with women who had had no full-term pregnancy after adjustment for age at diagnosis, stage of disease (tumour size, axillary nodal status, and histological grading), and reproductive history before diagnosis. The effect was also not significantly modified by age at diagnosis, tumour size, nodal status, or reproductive history before diagnosis of breast cancer. Neither miscarriages nor induced abortions after breast-cancer treatment influenced the prognosis.
We found no evidence that a pregnancy after breast-cancer treatment increased the risk of a poor outcome.
雌激素是乳腺癌中一种已被确认的生长因子。因此，关于是否应建议乳腺癌患者在治疗后不要怀孕，一直存在诸多讨论，因为怀孕相关的高雌激素浓度可能会产生负面的预后影响。
我们研究了5725例原发性乳腺癌女性患者。这些女性的信息来自丹麦乳腺癌合作组。自1977年以来，该组织收集了丹麦乳腺癌女性患者基于人群的肿瘤特征、治疗方案及随访状态的数据。生殖史细节来自丹麦民事登记系统、国家出生登记处和国家人工流产登记处。我们估计了乳腺癌治疗后怀孕的女性与未怀孕女性相比的相对死亡风险。
5725例诊断时年龄小于45岁的原发性乳腺癌女性患者接受了35067患者年的随访。其中，173例女性在乳腺癌治疗后怀孕。在根据诊断时年龄、疾病分期（肿瘤大小、腋窝淋巴结状态和组织学分级）以及诊断前生殖史进行调整后，乳腺癌治疗后足月妊娠的女性与未足月妊娠的女性相比，死亡风险有非显著性降低（相对风险0.55 [95%可信区间0.28 - 1.06]）。该效应也未因诊断时年龄、肿瘤大小、淋巴结状态或乳腺癌诊断前生殖史而有显著改变。乳腺癌治疗后的流产和人工流产均未影响预后。
我们没有发现证据表明乳腺癌治疗后怀孕会增加不良结局的风险。
