乳腺癌女性的妊娠时机与生存是否无关?

12-11 08:48 首页 SIBCS


前情提要


  2017年9月7日,《美国医学会杂志肿瘤学分册》在线发表赫尔利医学中心、密歇根州立大学针对上述研究的通讯:乳腺癌女性的妊娠时机与生存是否无关?


  上述研究发现妊娠与未妊娠的乳腺癌女性相比,生存无显著差异。乳腺癌诊断≥6个月后发生妊娠女性的5年精算生存率为97%,未妊娠女性为88%,根据年龄进行校正后的风险比为0.22。


  根据该研究的表6,其中53%的被分析患者肿瘤大小未知,此外55%的患者淋巴结状态未知【1】。由于肿瘤大小和淋巴结状态均与生存有相关性【2】,如此比例的缺失数据可能影响作者的结论。虽然肿瘤大小与淋巴结转移之间存在相关性,但是两个因素的预后价值互相独立。另一方面,未知的受体状态也可能影响结果。


  曲妥珠单抗是用于HER2阳性乳腺癌的重要药物,妊娠为其禁忌证。该研究亦未提供被研究患者的曲妥珠单抗使用信息。曲妥珠单抗术后辅助治疗一年与总生存率改善有相关性(风险比:0.67,95%置信区间:0.57~0.80)【3】。该研究所用特定疗法信息的缺失可能影响结果。


  不过,虽然该研究存在上述局限,但是提供了妊娠与总生存之间相关性的深入分析。


参考文献

  1. Iqbal J, Amir E, Rochon PA, et al. Association of the timing of pregnancy with survival in women with breast cancer. JAMA Oncol. 2017;3(5):659-665.

  2. Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer. 1989;63(1):181-187.

  3. Moja L, Tagliabue L, Balduzzi S, et al. Trastuzumab containing regimens for early breast cancer. Cochrane Database Syst Rev. 2012;4(4):CD006243.


JAMA Oncol. 2017 Sep 7. [Epub ahead of print]


Timing of Pregnancy and Survival in Women With Breast Cancer.


Al Hadidi S.


Hurley Medical Center, Flint; Michigan State University, Flint, Michigan.


Iqbal et al[1] reported no survival difference in pregnant compared with nonpregnant women with a breast cancer diagnosis in a recent JAMA Oncology article. The 5-year actuarial survival rate was 97% for women who had pregnancy 6 months or more after diagnosis of breast cancer vs 88% for women with no pregnancy, with age-adjusted hazard ratio of 0.22.[1] According to eTable 6 in their study, 53% of the analyzed patients are labeled with unknown tumor size. Moreover, 55% of the patients lymph node status was unknown. Such a degree of missing data can affect the authors conclusion given the survival relationship with both tumor size and nodal status.[2] Despite correlation between tumor size and nodal involvement, the prognostic value of the 2 factors is independent. On the other hand, unknown receptor status may affect the results.


Trastuzumab, an important medication used in human epidermal growth factor receptor 2 (HER2)-positive breast cancer, is contraindicated in pregnancy. The study did not provide information on the use of trastuzumab by the studied patients. One-year therapy of trastuzumab as adjuvant therapy was associated with an improvement in overall survival (hazard ratio, 0.67; 95% CI, 0.57-0.80).[3] Lack of information on specific therapy used in the study may alter the results. Despite those limitations, the study provided an insight on the association between pregnancy and overall survival.


REFERENCES

  1. Iqbal J, Amir E, Rochon PA, et al. Association of the timing of pregnancy with survival in women with breast cancer. JAMA Oncol. 2017;3(5):659-665.

  2. Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer. 1989;63(1):181-187.

  3. Moja L, Tagliabue L, Balduzzi S, et al. Trastuzumab containing regimens for early breast cancer. Cochrane Database Syst Rev. 2012;4(4):CD006243.


PMID: 28880981


DOI: 10.1001/jamaoncol.2017.2711




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