越来越多女性在妊娠期间发现乳腺癌，或在发现乳腺癌之后妊娠，了解妊娠对乳腺癌女性生存的影响，将有助于这些女性的就诊和治疗，那么妊娠是否增加乳腺癌女性的死亡风险？
2017年3月9日，《美国医学会杂志肿瘤学分册》在线发表多伦多大学、女子学院研究所、女子学院医院、玛格丽特公主医院、加拿大临床评估科学研究所的研究报告，将女性妊娠期间或产后诊断为乳腺癌的总生存，与女性诊断为乳腺癌但未妊娠的总生存进行了比较。
该人群回顾队列研究，将加拿大安大略省健康管理数据库整整12年期间（2003年1月1日～2014年12月31日）7553位20～45岁诊断为浸润性乳腺癌的女性，分为4组：未妊娠、乳腺癌诊断之前5年内妊娠、妊娠期间诊断乳腺癌、乳腺癌诊断之后5年内妊娠。
主要结局衡量指标为各组5年精算生存率、妊娠对总生存影响的年龄校正和多变量风险比、乳腺癌诊断后妊娠女性的时间推移风险比。
结果发现，7553位女性（诊断时年龄：平均39.1岁、中位40岁、范围20～44岁）的5年精算生存率：
未妊娠的乳腺癌女性：87.5%（95%置信区间：86.5%～88.4%）
乳腺癌之前妊娠女性：85.3%（95%置信区间：82.8%～87.8%）
乳腺癌相关妊娠女性：82.1%（95%置信区间：78.3%～85.9%）
乳腺癌之前、相关（妊娠期间诊断、诊断之后妊娠）妊娠女性，与未妊娠乳腺癌女性相比，年龄校正风险仅仅分别增加3%、18%：
乳腺癌之前妊娠女性：1.03（95%置信区间：0.85～1.27，P=0.73）
乳腺癌妊娠相关女性：1.18（95%置信区间：0.91～1.53，P=0.20）
妊娠组之间的生存差异无统计学意义。
值得注意的是，乳腺癌诊断≥6个月后妊娠女性的5年精算生存率为96.7%（95%置信区间：94.1%～99.3%），与未妊娠乳腺癌女性相比，年龄校正风险反而显著减少78%（0.22，95%置信区间：0.10～0.49，P＜0.001）。
因此，妊娠期间、之后发现乳腺癌，不会显著增加死亡风险，妊娠对于乳腺癌女性生存并无显著不良影响。
对于希望妊娠的乳腺癌生存者，如果诊断后≥6个月妊娠，死亡风险最低，甚至低于未妊娠乳腺癌女性。
相关阅读
JAMA Oncol. 2017 Mar 9. [Epub ahead of print]
Association of the timing of pregnancy with survival in women with breast cancer.
Javaid Iqbal, Eitan Amir, Paula A. Rochon, Vasily Giannakeas, Ping Sun, Steven A. Narod.
University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Ontario, Canada; Women's College Hospital, Ontario, Canada; Princess Margaret Hospital, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
This study compares the overall survival of women diagnosed with breast cancer during pregnancy or in the postpartum period with that of women who had breast cancer but did not become pregnant.
KEY POINTS
QUESTION: Does pregnancy increase the risk of death in women with breast cancer?
FINDINGS: In this cohort study of 7553 women with breast cancer, the 5-year overall survival was 87.5% for women with no pregnancy, 82.1% for women with pregnancy-associated breast cancer, and 96.7% for women who had pregnancy 6 months or more after diagnosis of breast cancer. The difference in survival between pregnancy groups was not statistically significant.
MEANING: Pregnancy around the time of, or after, diagnosis of breast cancer, does not worsen survival.
ABSTRACT
IMPORTANCE: Increasing numbers of women experience pregnancy around the time of, or after, a diagnosis of breast cancer. Understanding the effect of pregnancy on survival in women with breast cancer will help in the counseling and treatment of these women.
OBJECTIVE: To compare the overall survival of women diagnosed with breast cancer during pregnancy or in the postpartum period with that of women who had breast cancer but did not become pregnant.
DESIGN, SETTING, AND PARTICIPANTS: This population-based, retrospective cohort study linked health administrative databases in Ontario, Canada, comprising 7553 women aged 20 to 45 years at the time of diagnosis with invasive breast cancer, from January 1, 2003, to December 31, 2014.
EXPOSURES: Any pregnancy in the period from 5 years before, until 5 years after, the index date of the diagnosis of breast cancer. Women were classified into the following 4 exposure groups: no pregnancy (the referent), pregnancy before breast cancer, pregnancy-associated breast cancer, and pregnancy following breast cancer.
MAIN OUTCOMES AND MEASURES: Five-year actuarial survival rates for all exposure groups, age-adjusted and multivariable hazard ratios [HRs] of pregnancy for overall survival for all exposure groups, and time-dependent hazard ratios for women with pregnancy following breast cancer.
RESULTS: Among the 7553 women in the study (mean age at diagnosis, 39.1 years; median, 40 years; range, 20-44 years) the 5-year actuarial survival rate was 87.5% (95% CI, 86.5%-88.4%) for women with no pregnancy, 85.3% (95% CI, 82.8%-87.8%) for women with pregnancy before breast cancer (age-adjusted hazard ratio, 1.03; 95% CI, 0.85-1.27; P=0.73), and 82.1% (95% CI, 78.3%-85.9%) for women with pregnancy-associated breast cancer (age-adjusted hazard ratio, 1.18; 95% CI, 0.91-1.53; P=0.20). The 5-year actuarial survival rate was 96.7% (95% CI, 94.1%-99.3%) for women who had pregnancy 6 months or more after diagnosis of breast cancer, vs 87.5% (95% CI, 86.5%-88.4%) for women with no pregnancy) (age-adjusted HR, 0.22; 95% CI, 0.10-0.49; P<.001).
CONCLUSIONS AND RELEVANCE: Pregnancy did not adversely affect survival in women with breast cancer. For breast cancer survivors who wish to conceive, the risk of death is lowest if pregnancy occurs 6 months or more after diagnosis.
DOI: 10.1001/jamaoncol.2017.0248
联系客服
