Eileen Morgan, Colette O'Neill, Richa Shah, Oliver Langselius, Yaqi Su, Clara Frick, Hanna Fink, Aude Bardot, Paul M Walsh, Ryan R Woods, Lou Gonsalves, Jan F Nygård, Serban Negoita, Esmeralda Ramirez-Pena, Karen Gelmon, Nicoleta Antone, Miriam Mutebi, Sabine Siesling, Fatima Cardoso, Julie Gralow, Isabelle Soerjomataram, Melina Arnold
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引用次数: 0
Abstract
Background: To assess proportions of metastatic recurrence in women initially diagnosed with non-metastatic breast cancer by stage at diagnosis, breast cancer subtype, calendar period and age.
Methods: A systematic search of MEDLINE and Web of Science databases (January 2010-12 May 2022) was conducted. Studies reporting the proportion of distant metastatic recurrence in women with non-metastatic breast cancer were identified and outcomes and characteristics were extracted. Risk of bias was assessed independently by two reviewers. Random-effects meta-analyses of proportions were used to calculate pooled estimates and 95% confidence intervals (CIs).
Results: 193 studies covering over 280,000 patients were included in the main analysis. Pooled proportions of metastatic recurrence increased with longer median follow-up time from 12.2% (95% CI 10.5-14.0%) at 1-4 years post diagnosis, 14.3% (95% CI 12.9-15.7%) at 5-9 years to 23.3% (95% CI 20.1-26.8) at 10 years or more. Regional variation was observed with pooled estimates ranging from 11.0% (95% CI 8.5-13.7%) in Europe to 26.4% (95% CI 16.7-37.4%) in Africa (1-4 years follow-up). Proportions of recurrence were higher in studies with diagnosis before 2000 (22.2%, 95% CI 15.1-30.3) compared to studies with diagnosis from 2000 onwards (12.8%, 95% CI 11.7-14.0). At 1-4 years median follow-up, pooled proportions of metastatic recurrence were higher in women with hormone receptor negative (15.2%, 95% CI 12.0-18.7%) compared with receptor positive disease (9.6%, 95% CI 6.2-13.6%) and in women with locally advanced (33.2%, 95% CI 24.7-42.3%) relative to early disease at initial diagnosis (4.8%, 95% CI 2.5-7.8%). Proportions were higher in those under 50 years compared with 70+ years, 18.6% (95% CI 15.9-21.4%) versus 13.3% (95% CI 9.2, 18.0%), respectively. Heterogeneity was high in all meta-analyses and results should be interpreted with caution.
Conclusions: Higher proportions of metastatic recurrence in patients initially diagnosed at an advanced stage and in earlier calendar period emphasises the importance of early detection and treatment advancements. As the global number of breast cancer survivors increases, research and health policy efforts should be directed towards timely diagnosis and access to effective treatments and care.
背景：根据诊断阶段、乳腺癌亚型和年龄，评估初次诊断为非转移性乳腺癌的女性转移性复发比例：根据诊断分期、乳腺癌亚型、日历期和年龄，评估最初诊断为非转移性乳腺癌的女性转移性复发的比例：对 MEDLINE 和 Web of Science 数据库（2010 年 1 月至 2022 年 5 月）进行了系统检索。方法：对 MEDLINE 和 Web Science 数据库（2010 年 1 月至 2022 年 5 月）进行了系统检索，确定了报告非转移性乳腺癌女性患者远处转移性复发比例的研究，并提取了研究结果和特征。偏倚风险由两名审稿人独立评估。采用比例随机效应荟萃分析法计算汇总估计值和 95% 置信区间 (CI)：主要分析共纳入193项研究，覆盖28万多名患者。随着中位随访时间的延长，转移性复发的汇总比例也在增加，从确诊后1-4年的12.2%（95% CI 10.5-14.0%）、5-9年的14.3%（95% CI 12.9-15.7%）到10年或更长时间的23.3%（95% CI 20.1-26.8）。地区间存在差异，综合估计值从欧洲的 11.0% (95% CI 8.5-13.7%) 到非洲的 26.4% (95% CI 16.7-37.4%)（随访 1-4 年）不等。与 2000 年以前诊断的研究（22.2%，95% CI 15.1-30.3）相比，2000 年以后诊断的研究（12.8%，95% CI 11.7-14.0）的复发比例更高。在1-4年的中位随访中，荷尔蒙受体阴性（15.2%，95% CI 12.0-18.7%）妇女的转移性复发比例高于受体阳性（9.6%，95% CI 6.2-13.6%）妇女的转移性复发比例，局部晚期（33.2%，95% CI 24.7-42.3%）妇女的转移性复发比例高于初诊时的早期疾病（4.8%，95% CI 2.5-7.8%）妇女的转移性复发比例。50岁以下人群的比例高于70岁以上人群，分别为18.6%（95% CI 15.9-21.4%）和13.3%（95% CI 9.2-18.0%）。所有荟萃分析的异质性都很高，因此在解释结果时应谨慎：结论：在晚期和较早诊断的患者中，转移性复发的比例较高，这强调了早期检测和治疗进步的重要性。随着全球乳腺癌幸存者人数的增加，研究和卫生政策应致力于及时诊断和获得有效的治疗和护理：研究注册号：PROCEMO CRD42022314500。
期刊介绍：
Breast Cancer Research, an international, peer-reviewed online journal, publishes original research, reviews, editorials, and reports. It features open-access research articles of exceptional interest across all areas of biology and medicine relevant to breast cancer. This includes normal mammary gland biology, with a special emphasis on the genetic, biochemical, and cellular basis of breast cancer. In addition to basic research, the journal covers preclinical, translational, and clinical studies with a biological basis, including Phase I and Phase II trials.
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