期刊
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
卷 97, 期 12, 页码 E2201-E2209出版社
ENDOCRINE SOC
DOI: 10.1210/jc.2012-2423
关键词
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资金
- National Natural Science Foundation of China [30971143, 30972936, 81001169]
- Shanghai United Developing Technology Project of Municipal Hospitals [SHDC12010116]
- Key Clinical Program of the Ministry of Health
- Zhuo-Xue Project of Fudan University
- Shanghai Committee of Science and Technology
Purpose: More than half of the patients with estrogen receptor (ER)-positive breast cancers will relapse and die from breast cancer at 5-10 yr after diagnosis despite 5-yr endocrine therapy. Subpopulations of ER-positive patients at high risk of breast cancer-specific mortality (BCSM) at 5-10 yr are undetermined. Methods: Using the Surveillance, Epidemiology, and End-Results program (1990-2003), we analyzed the relative hazard ratio (HR) and absolute HR of BCSM and the cumulative 10-yr breast cancer-specific survival (BCSS) in 111,993 breast cancer patients, stratified by ER, age, and lymph node (LN), and adjusted for other prognostic factors. Results: At 5-10 yr after diagnosis, ER-positive patients had increased risk of BCSM [HR, 0.71; 95% confidence interval (CI), 0.66-0.76; ER-positive as reference] compared with ER-negative patients. Specifically, younger ER-positive patients (<40 yr) had a constant plateau of annual hazard rate, a higher hazard of BCSM (HR, 0.43; 95% CI, 0.35-0.52; ER-positive as reference), and poor 10-yr BCSS, despite LN status. Among ER-positive patients aged 40-60 yr having no obvious plateau of hazard rate, only those with LN-positive disease had a significantly increased hazard of BCSM and poor 10-yr BCSS. Elderly ER-positive patients aged 60-74 yr had a hazard of BCSM, similar to that of ER-negative patients, and those with LN-positive disease had poor 10-yr BCSS. Conclusion: Our findings help to define the ER-positive subpopulations at higher risk of BCSM at 5-10 yr after diagnosis and are useful in choosing candidates for clinical trials of extended endocrine therapy after 5-yr treatment and in guiding individualized treatment. (J Clin Endocrinol Metab 97: E2201-E2209, 2012)
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