乳腺癌确诊后患者死亡原因大数据分析

　　对于乳腺癌患者死亡的非癌症原因，目前研究关注不足。

　　2019年12月16日，美国癌症学会《癌症》在线发表埃及艾因夏姆斯大学、开罗大学、美国克利夫兰医学中心、底特律圣约翰医院、凤凰城梅奥医学中心的美国人群大数据分析研究报告，对乳腺癌确诊后患者死亡原因进行了评定和量化。

　　该研究从美国国家癌症研究所（NCI）监测流行病学最终结果（SEER）数据库共检索到2000～2015年期间确诊乳腺癌女性75万4270例，并与美国国家卫生统计中心1969～2016年全国人口死亡数据进行比较，计算不同死亡原因的标准化死亡率。

　　结果，随访期间，患者死亡18万3002例（24.3%），其中大部分（46.2%）死于确诊后1～5年内。大多数死亡由于乳腺癌本身或其他癌症所致，并且随着确诊后岁月的流逝，乳腺癌死亡人数逐年减少。

　　最常见的死亡原因：

• 确诊0～1年：乳腺癌65.4%、心脏病10%、其他癌6.7%、脑血管病2.4%、慢性阻塞性肺病2%

• 确诊1～5年：乳腺癌58.6%、心脏病11.2%、其他癌8.9%、脑血管病2.7%、慢性阻塞性肺病3%、阿尔茨海默病1.6%

• 确诊5～10年：乳腺癌38.2%、心脏病15.7%、其他癌13.4%、脑血管病3.9%、慢性阻塞性肺病3.9%、阿尔茨海默病3.4%

• 确诊>10年：乳腺癌23.6%、心脏病19.3%、其他癌15.5%、阿尔茨海默病5.3%、脑血管病5.2%、慢性阻塞性肺病4.9%

　　与普通人群相比：

• 确诊5～10年：慢性肝病死亡率高1.23倍（95%置信区间：1.09～1.38）

• 确诊>10年：阿尔茨海默病死亡率高1.21倍（95%置信区间：1.14～1.29）

• 确诊>10年：心脏病死亡率高1.06倍（95%置信区间：1.02～1.09）

　　因此，该研究结果表明，对于乳腺癌患者，虽然乳腺癌仍为乳腺癌确诊后最常见的死亡原因，但是心脏病和脑血管病等其他非乳腺癌死亡原因，也造成了相当数量的死亡。这些结果为乳腺癌康复者未来健康风险咨询提供了重要数据。

Cancer. 2019 Dec 16. [Epub ahead of print]

Causes of death after breast cancer diagnosis: A US population-based analysis.

Afifi AM, Saad AM, Al-Husseini MJ, Elmehrath AO, Northfelt DW, Sonbol MB.

Ain Shams University, Cairo, Egypt; Cleveland Clinic Foundation, Cleveland, Ohio; Ascension St John Hospital, Detroit, Michigan; Cairo University, Cairo, Egypt; Mayo Clinic Cancer Center, Mayo Clinic, Phoenix, Arizona.

The objective of this study is to assess and quantify noncancer causes of death after a breast cancer diagnosis. Among 183 of 754,270 patients with breast cancer (24.3%) who die during the follow-up period, the most common noncancer causes of death are heart diseases, cerebrovascular diseases, chronic obstructive pulmonary disease, and Alzheimer disease.

BACKGROUND: The focus on noncancer causes of death in patients with breast cancer (BC) remains superficial. The objective of the current study was to assess and quantify causes of death after BC diagnosis.

METHODS: In total, 754,270 women with BC in the United States who were diagnosed during 2000 through 2015 and retrieved from the Surveillance, Epidemiology, and End Results (SEER) program were studied. Standardized mortality ratios (SMRs) for causes of death were calculated.

RESULTS: Of the included patients, 183,002 (24.3%) died during the follow-up period. The greatest proportion of deaths (46.2%) occurred within 1 to 5 years after diagnosis. Most deaths occurred from BC itself or from other cancers, and the number of BC deaths decreased as more years passed after diagnosis. The most common noncancer causes of death within <10 years after diagnosis were heart diseases followed by cerebrovascular diseases. However, >10 years after diagnosis, the most common noncancer causes of death were heart diseases followed by Alzheimer disease. Patients had a statistically significant higher risk of death from chronic liver diseases within 5 to 10 years after diagnosis compared with the general population (SMR, 1.23; 95% CI, 1.09-1.38) and had statistically significant higher risks of death from Alzheimer disease (SMR, 1.21; 95% CI, 1.14-1.29) and from diseases of the heart (SMR, 1.06; 95% CI, 1.02-1.09) >10 years after diagnosis.

CONCLUSIONS: Although BC remains the most common cause of death after BC diagnosis, other non-BC causes of death (mainly heart and cerebrovascular diseases) represent a significant number of deaths among patients with BC. These findings provide important insight into how BC survivors should be counselled regarding future health risks.

KEYWORDS: breast cancer; cancer survivorship; causes of death; nonbreast cancer deaths; Surveillance; Epidemiology; and End Results (SEER) database

DOI: 10.1002/cncr.32648