基于SEER数据库分析142 007例乳腺癌诊断时婚姻状态与预后的关系

Analysis of association between marital status at diagnosis and prognosis in 142 007 patients with breast cancer based on SEER database

摘要:

目的：探讨乳腺癌诊断时的婚姻状态与乳腺癌特异生存（breast cancer specific survival，BCSS）的关系。方法：提取美国癌症监测、流行病学和结果（the Surveillance，Epidemiology，and End Results，SEER）数据库2010年至2014年病理诊断为浸润性乳腺癌的病例资料，回顾性分析诊断时婚姻状态（已婚、未婚、离婚、分居和丧偶）与BCSS的关系，采用单因素和多因素Cox风险比例模型分析婚姻状态对乳腺癌及不同亚型患者BCSS的影响。结果：共纳入142 007例患者，中位随访28个月（IQR：2~59个月），乳腺癌特异死亡6 685例。不同婚姻状态患者间的年龄、肿瘤分期、组织学分级、雌激素受体（estrogen receptor，ER）、孕激素受体（progesterone receptor，PR）、人表皮生长因子受体-2（human epidermal growth factor 2，HER2）、分子分型及手术、化疗、放疗分布不均衡（P＜0.001）。多因素Cox风险模型分析显示，相比已婚患者，未婚（HR=1.26，95%CI=1.18~1.35，P＜0.001）、离婚（HR=1.11，95%CI=1.07~1.16，P＜0.001）、分居（HR=1.18，95%CI=1.16~1.20，P＜0.001）和丧偶（HR=1.10，95%CI=1.03~1.18，P＜0.001）是乳腺癌患者的不良预后因素。根据分子分型进行亚组分析，分居不影响HR-/HER2+、HR+/HER2+和HR-/HER2-患者的预后（P＞0.05），离婚不影响HR-/HER2-患者的预后（P＞0.05）。经年龄段校正，未婚是各年龄段乳腺癌患者的不良预后因素；离婚是60～69岁年龄段患者的不良预后因素（HR=1.18，95%CI=1.10~1.27，P＜0.001）；分居影响49岁以下及60～69岁年龄段患者的预后（P＜0.05）；丧偶是≥70岁患者的不良预后因素（HR=1.10，95%CI=1.07~1.13，P＜0.001）。结论：诊断时婚姻状态与乳腺癌预后显著相关，未婚、离婚、分居和丧偶是患者预后的不良因素，婚姻状态对不同年龄段及不同分子亚型乳腺癌患者预后的影响不甚相同。

Abstract:

Objective：To investigate the association between marital status at diagnosis and breast cancer specific survival（BCSS）. Methods：Data of patients who were diagnosed with breast cancer between 2010 and 2014 were extracted from the Surveillance，Epi－demiology，and End Results（SEER） database. Association between marital status（married，single，divorced，separated and widowed） and BCSS was retrospectively analyzed by univariate and multivariate Cox proportional hazards models. Results：A total of 142 007 patients were enrolled，with a median follow-up of 28 months（IQR：2-59 months），and 6685 patients were died with specific breast cancer. There were significant imbalances in clinicopathologic characteristics[age，tumor stage，histological grade，estrogen receptor（ER），progesterone receptor（PR），human epidermal growth factor 2（HER2），molecular type，chemotherapy and radiation therapy] between patients with different marital status（all P<0.001）. Multivariate Cox proportional hazards model analyses showed that the single（HR=1.26，95%CI=1.18 to 1.35，P<0.001），the divorced（HR=1.11，95%CI=1.07 to 1.16，P＜0.001），the widowed（HR=1.10，95%CI=1.03 to 1.18，P<0.001） and the separated（HR=1.18，95%CI=1.16 to 1.20，P＜0.001） were bad prognostic factors for breast cancer patients when compared with married patients. Subgroup analysis showed that separation had no influences on patients with a subtype of HR-/HER2+，HR+/HER2+ or HR-/HER2-，and divorce was not associated with the BCSS in HR-/HER2- subtype patients（P>0.05）. After the correction of age，single was a poor prognostic factor for breast cancer patients of all ages. Divorce was a poor prognostic factor for patients aged 60 to 69 years old（HR=1.18，95%CI=1.10 to 1.27，P<0.001）. Separation influenced the prognosis of patients aged less than 49 years old and 60 to 69 years old（P<0.05）. Widowhood was a poor prognostic factor for patients aged 70 years old or older（HR=1.10，95%CI=1.07 to 1.13，P<0.001）. Conclusion：Marital status at diagnosis is significantly correlated with prognosis of breast cancer and has different influences on the prognosis of patients with different age groups and molecular subtypes.