产后乳腺癌和患有生殖系BRCA病原性变异的妇女的生存率
Zhenzhen Zhang1,2, Shangyuan Ye3, Sarah M Bernhardt4
1Division of Oncological Sciences, Oregon Health & Science University, Portland.
JAMA network open
|April 19, 2024
概括
在患有BRCA致病变体 (PVs) 的妇女分娩后10年内诊断出幼发性乳腺癌 (YOBC),与死亡率增加有关. BRCA1载体和雌激素受体阳性癌症的风险最高,在分娩后五年内诊断出来.
科学领域:
- 在瘤学瘤学.
- 遗传学 遗传学是一种遗传学.
- 生殖健康 生殖健康
背景情况:
- 在分娩后5-10年内诊断的幼发性乳腺癌 (YOBC) 与更高的死亡率有关.
- 患有生殖系BRCA1/2致病变体 (PVs) 的女性患早期乳腺癌 (BC) 的风险增加.
- 最近分娩对BRCA突变YOBC死亡风险的具体影响尚不清楚.
研究的目的:
- 在被诊断为YOBC的妇女和携带生殖系BRCA1/2 PVs的妇女中,调查最近分娩以来的时间和死亡风险之间的关联.
- 确定可能特别易受伤害的特定风险窗口和患者子组 (例如,根据ER状态,BRCA1/2状态).
主要方法:
- 对903名患有生殖系BRCA1/2PV的女性进行前性队列研究,诊断出I-III期BC在45岁以下 (1950-2021,英国).
- 暴露时间定义为最后一次分娩和BC诊断 (0-10年,分层为0-5年和5-10年) 之间的时间.
- 主要结局:诊断后长达20年的全因死亡率评估,使用根据年龄,阶段,ER和BRCA状态调整的考克斯回归分析.
主要成果:
- 在分娩后5-10年内诊断与所有原因死亡率 (HR,1.56) 的增加有关,与无产妇妇女或分娩后≥10年被诊断的妇女相比.
- 对于ER阳性BC诊断在产后5年以下 (HR, 2.35) 和ER阴性BC诊断在产后5-10年 (HR, 3.12) 观察到较高的死亡风险.
- 在5-10年产后组的死亡率增加仅对BRCA1携带者 (HR,2.03) 有意义,而不是BRCA2携带者.
结论:
- 在分娩后10年内诊断的BRCA PV载体中的YOBC与全因死亡率的升高有关.
- 存在特定的风险概况:ER阳性BC<5年产后和ER阴性BC5-10年产后.
- 产后5-10年被诊断为BRCA1携带者面临最高的死亡风险,这强调了需要量身定制的遗传咨询和管理策略的需要.
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