Background: Pregnancy concurrent with, shortly before, or after breast cancer poses unique challenges because hormonal changes in pregnancy potentially interact with breast cancer outcomes.
Materials and methods: We studied a cohort of 3,687 female patients of reproductive age (<50 years) with breast cancer, linking a large institutional database and the nationwide claims database to comprehensively capture exposure status and tumor characteristics. Exposures included breast cancer during pregnancy, postpartum breast cancer (<12 months after delivery), and pregnancy after breast cancer.
Results: Forty-five patients with postpartum breast cancer were significantly more likely to have advanced stage, hormone receptor-negative tumor and to be younger than 35 years at diagnosis than those without postpartum breast cancer. This trend was not observed with 18 patients with breast cancer during pregnancy. The unadjusted 5-year survival rates were 77% versus 96% for patients with postpartum breast cancer versus their counterparts, 89% versus 96% for patients with breast cancer during pregnancy versus their counterparts, and 98% versus 96% for patients with pregnancy after breast cancer versus their counterparts, respectively. In the multivariable analyses, postpartum breast cancer exhibited hazard ratios for death of 1.57 (95% confidence interval [CI], 0.82-2.99), whereas those for breast cancer during pregnancy and pregnancy after breast cancer were 1.09 (95% CI, 0.15-7.91) and 0.86 (95% CI, 0.26-2.83), respectively.
Conclusion: Postpartum breast cancer, but not breast cancer during pregnancy, was associated with advanced stage, younger age at diagnosis (<35 years), hormone receptor-negative disease, and poorer survival. Pregnancy after breast cancer did not compromise overall survival.
Implications for practice: Although pregnancy around the time of diagnosis of breast cancer is expected to become increasingly common with maternal age at first childbirth on the rise, data on the prognostic impact of pregnancy have been inconsistent and rare from Asian populations. In this investigation of a Korean patient cohort with breast cancer, pregnancy-associated breast cancer was associated with advanced stage, younger age at diagnosis (<35 years), hormone receptor-negative disease, and poorer survival. This adverse impact of pregnancy on the prognosis was apparent with postpartum breast cancer but not observed with breast cancer during pregnancy. Pregnancy after breast cancer did not compromise overall survival.
摘要
背景。在患有乳腺癌的同时、不久之前或之后妊娠会带来独特的挑战，因为妊娠期间的激素变化可能会与乳腺癌的结局相互作用。
材料和方法。我们研究了一支由 3 687 名育龄女性(<50 岁)乳腺癌患者组成的队列，将一个大型机构数据库与全国范围的索赔数据库相连接，以全面捕获暴露状态和肿瘤特征。暴露项包括妊娠期乳腺癌、产后乳腺癌(分娩后 <12 个月)和患乳腺癌后妊娠。
结果。与未患产后乳腺癌的患者相比，45 例产后乳腺癌患者明显更易患晚期激素受体阴性肿瘤，且诊断时年龄小于 35 岁。未在 18 名妊娠期乳腺癌患者中观察到此趋势。对于未校正的 5 年生存率，产后乳腺癌患者与对照组相比，分别为 77% 和 96%，妊娠期乳腺癌患者与对照组相比，分别为 89% 和 96%，患乳腺癌后妊娠的患者与对照组相比，分别为 98% 和 96%。在多变量分析中，产后乳腺癌的死亡风险比为 1.57 [95% 置信区间 (CI)，0.82‐2.99]，而妊娠期乳腺癌和患乳腺癌后妊娠的死亡风险比分别为 1.09(95% CI，0.15‐7.91)和 0.86(95% CI，0.26‐2.83)。
结论。产后乳腺癌(非妊娠期乳腺癌)与癌症较晚期、诊断时年龄较轻(<35 岁)、激素受体阴性疾病和较差的生存率有关。患乳腺癌后妊娠并不影响总生存率。
实践意义:尽管随着首次分娩时孕妇年龄的增加，预计在乳腺癌诊断前后妊娠的现象将变得越来越普遍，但有关妊娠预后影响的数据一直不一致，而且在亚洲人群中很少见。在此项针对韩国乳腺癌患者队列的调查中，妊娠相关乳腺癌与癌症较晚期、诊断时年龄较轻(<35 岁)、激素受体阴性疾病和较差的生存率有关。妊娠对预后的不良影响在产后乳腺癌中很明显，但未在妊娠期乳腺癌中观察到此影响。患乳腺癌后妊娠并不影响总生存率。
Keywords: Breast cancer; Postpartum; Pregnancy; Pregnancy‐associated breast cancer.
© AlphaMed Press 2019.