在综合医疗体系中,有乳腺癌个人史的女性发生原发性肺癌的风险及后续治疗方式分析
Risk of Primary Lung Cancer in Women with Personal History of Breast Cancer and Subsequent Treatment Modality in an Integrated Health System.
作者
作者单位
- Department of Surgery, UCSF East Bay, Oakland, CA. Electronic address: andrea.gochi@ucsf.edu.
- Kaiser Permanente Division of Research, Pleasanton, CA.
- Department of Surgery, UCSF East Bay, Oakland, CA.
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA; UCSF School of Medicine, San Francisco, CA; Department of Thoracic Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA.
摘要
中文
乳腺癌是美国女性最常见的恶性肿瘤,其幸存者面临包括肺癌在内的后续恶性肿瘤风险增加。以往研究报告了乳腺癌治疗与肺癌之间的关联,但当代数据仍有限。本研究在综合医疗体系中评估乳腺癌后肺癌风险,并按治疗方式进行分层分析。本研究在Kaiser Permanente Northern California内对2010年至2021年确诊为乳腺癌的女性进行回顾性队列研究。排除标准包括诊断前或诊断后早期发生的肺癌、早期死亡或未加入该健康计划。主要结局为后续原发性肺癌。采用竞争风险方法(以死亡为竞争事件)估计累积发病率,并使用Fine-Gray回归评估乳腺癌治疗的相关性。在中位随访4.6年的42,290名女性中,324例(0.8%)发生肺癌。五年累积发病率为0.66%,在当前吸烟者中发病率最高(2.9%),65-74岁及≥75岁女性发病率分别为1.1%和1.2%。在校正人口学、临床及肿瘤相关因素后,乳腺癌治疗暴露与肺癌无显著相关性。西班牙裔女性发生肺癌的风险显著低于白人女性(HR 0.54,95% CI 0.33-0.88)。乳腺癌幸存者的肺癌风险随时间增加,但该风险主要由患者自身因素驱动,而非乳腺癌治疗暴露所致。
English
Breast cancer is the most common malignancy among U.S. women, and survivors face increased risk for subsequent malignancies, including lung cancer. Prior studies have reported associations between breast cancer treatments and lung cancer, but contemporary data remain limited. This study evaluates lung cancer risk following breast cancer, stratified by treatment modality, within an integrated health system. A retrospective cohort study of women diagnosed with breast cancer from 2010-2021 was conducted within Kaiser Permanente Northern California. Exclusion criteria included prior or early post-diagnosis lung cancer, early death, or lack of health plan membership. The primary outcome was subsequent primary lung cancer. Cumulative incidence was estimated using competing-risk methods, with death as a competing event. Associations with breast cancer treatments were evaluated using Fine-Gray regression. Among 42,290 women followed for a median of 4.6 years, 324 (0.8%) developed lung cancer. The five-year cumulative incidence was 0.66%, with the highest incidence among current smokers (2.9%) and women aged 65-74 years and ≥75 years (1.1% and 1.2%, respectively). After adjusting for demographic, clinical, and tumor-related factors, breast cancer treatment exposures were not associated with lung cancer. Hispanic women demonstrated a significantly lower hazard of lung cancer compared with White women (HR 0.54, 95% CI 0.33-0.88). Lung cancer risk among breast cancer survivors has increased over time, however risk was driven by patient-level factors, rather than breast cancer treatment exposures.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q1
- 影响因子
- 5.3