乳腺癌流行病学及伴随疾病现状课件

1、首席专家论坛全方位 全周期第二届中国乳腺癌乳腺癌及伴随疾病流行及其人群研究现状郑 莹女性癌症发病和死亡：发达国家 vs 中国顺位发病死亡发达国家中国发达国家中国1乳腺（27.9%）肺肺肺2结直肠乳腺（15.1%）乳腺（15.4%）胃3肺胃结直肠肝4子宫体结直肠胰腺结直肠5卵巢肝胃食管6胃子宫体卵巢乳腺（6.2%）7甲状腺食管肝子宫体8胰腺子宫颈白血病胰腺9皮肤黑色素瘤甲状腺子宫颈膀胱10NHL卵巢子宫体白血病Globocan 2012中国2015癌症估计全球女性乳腺癌发病、死亡时间趋势全球乳腺癌发病的差异逐步缩小2004-2008年诊断的20272例上海户籍乳腺癌患者5年观察生存率 81.64

2、%5年相对生存率 91.81%Concord-3的中美乳腺癌生存资料CONCORD-3研究显示乳腺癌目前依旧是全世界发生率最高的女性肿瘤，而在全球数据中仅登记了中国大陆53791例（美国登记159976例），对于中国的数据登记完整度与认识是不足的。我们需要进一步认识中国乳腺癌的特殊性。中国乳腺癌生存资料仍不足中国乳腺癌生存的城乡差异乳腺癌患者的10年生存StageNo. of patientsNo. of events5-Year survival rate (%)10-Year survival rate (%)012,28526698.395.4I39,2841,55796.692.7II

3、40,0243,95191.884.8III13,7746,54475.863.4IV1,6191,02934.022.2Unknown2,998343-Total109,98810,69091.284.8Stage-specific 5- and 10-year overall survival rates (20012012, Korean Breast Cancer Society registry data)J Breast Cancer. 2017 Mar; 20(1): 111. Published online 2017 Mar 24. doi: 10.4048/jbc.2017

4、.20.1.1PMCID: PMC5378568Basic Facts of Breast Cancer in Korea in 2014: The 10-Year Overall Survival ProgressEun Hwa Park, Sun Young Min,1 Zisun Kim,2 Chan Seok Yoon,3 Kyu-Won Jung,4 Seok Jin Nam,5 Se Jeong Oh,6 Seeyoun Lee,7 Byeong-Woo Park,8 Woosung Lim,9 Min Hee Hur, 10 and Korean Breast Cancer So

5、ciety美国乳腺癌10年生存率SEER资料1973年诊断 61%1993年诊断 83%中国乳腺癌10年生存率上海队列资料观察生存率 80.5%无病生存率 78.8%Oncologist. 2015 Sep;20(9):1044-50. doi: 10.1634/theoncologist.2014-0290. Epub 2015 Aug 3. Breast Cancer Disparities: A Multicenter Comparison of Tumor Diagnosis, Characteristics, and Surgical Treatment in China and t

6、he U.S.中国医生遇到的是更复杂的患者中国乳腺癌与美国不一样更年轻，瘤体更大，淋巴结阳性更多，分期更晚上海女性乳腺癌发病年龄分布的时间趋势6510% 10% 20% 20% 10% 30%在上海、北京、天津、广州等发达地区乳腺癌的诊治与生存与美国看齐Allemani C, et al. Lancet. 2018 Jan 30. pii: S0140-6736(17)33326-3. CA CANCER J CLIN 2016;66:115132. 乳腺癌：基础与临床的转化83.2%中国女性乳腺癌5年生存估计90.2%美国5年生存率7.3%2004-2014十年生存率变化3.9%发病率年度变

7、化年新发乳腺癌人数27万+年新发病人数超过美国，世界最多1.1%死亡率年度变化VS.中国乳腺癌患者数量增长，需求增长乳腺癌预防的目标减少新发病例推迟发病年龄降低死亡风险对乳腺癌预后的认识转变13预后转移复发生活质量抑郁认知并发疾病第二原发肿瘤死亡癌症死亡非癌症死亡其他疾病的竞争死亡生存时间延长诊断时年龄后移治疗依从性治疗规范性复发转移伴随疾病生活方式乳腺癌长期预后的影响因素乳腺癌患者的管理目标早期治愈，提升生存，促进生活质量。乳腺癌患者全方位生存提升促进乳腺癌规范治疗提升乳腺癌依从性及伴随疾病管理促进饮食及生活方式改变存在慢性病发疾病影响癌症的发生风险发表在BMJ上面的就研究了1996年到20

8、07年来自宝岛台湾共计405878 人的数据，进行随访分析之后，得出了8种影响癌症发生的独立慢性疾病因素BMJ 2018;360:k134慢性疾病和标志物以及癌症发生的风险慢性疾病和标志物与癌症死亡率的风险具有统计学显着相关性，并且这些关联性通常比癌症发病率更强BMJ 2018;360:k134存在慢性病发疾病影响癌症患者死亡风险相关研究StudyTypeYear of PublicComorbidityBC mortalitytotal mortailtyLand,Review2012Charlson Comorbidity Score+LACECohort+Yancik2001stroke

9、+asthma+diabetes+hypertension-PatnaikSEER201213 specific comorbid condition+PatnaikSEER2012diabetes+CVD+LouwmanNetherlands2005diabetes+Janssen-Heijnen2007CVD+hypertensionnullnullWHELdiabetes+osteoporosis-并发疾病与乳腺癌生存：来自上海的研究报告分析包括2002 - 2006年期间被诊断患有I-III期乳腺癌20-75岁的4664名妇女，研究调查了主要合并症与乳腺癌预后的关系Breast Can

10、cer Res Treat. 2013 May; 139(1): 227235.NHypertensionDiabetesCHDStrokeChronic Gastritisn%n%n%n%n%Age at diagnosis, y502,0931728.2391.930.1430.1422610.850591,37230622.3624.5433.1161.222616.5601,19956747.3a18715.6a18615.5a826.8a21718.1aTNM stagebI1,62236022.2875.4845.2342.128217.4II2,39453022.11476.11

11、134.7482.030512.7III44511024.7378.3a235.2132.94911.0aER/PR statusbER+/PR+2,37953722.61476.21154.8562.434414.5ER+/PR61616827.3437.0386.2162.68614.0ER/PR+3516217.7133.7113.151.45014.3ER/PR1,30426920.6a836.4675.1221.718914.5BMI (kg/m2)25.03,04748616.01555.11103.6521.746015.125.029.991,36242631.31138.39

12、26.8423.218413.53025513352.2a207.8a3011.8a72.7a259.7aa P value 0.05 based on Chi square testb Excludes unknown (for TNM, n = 203; for ER/PR n = 14)乳腺癌：并发疾病普遍存在hypertension (22.4%), chronic gastritis (14.3%), diabetes mellitus (6.2%),chronicbronchitis/asthma (5.8%), coronary heart disease (5.0%), and

13、 stroke (2.2%).NHypertensionDiabetesCHDStrokeChronic Gastritisn%n%n%n%n%MastectomycNo3055618.4175.6154.9103.34414.4Yes4,35998922.72716.22175.0912.162514.3ChemotherapyNo35516646.86217.56117.2246.86117.2Yes4,30987920.4a2265.2a1714.0a771.8a60814.1RadiotherapyNo3,12778225.02096.71896.0772.547615.2Yes1,5

14、3726317.1a795.1a432.8a241.619312.6aTamoxifen useNo2,24450022.31426.31064.7462.132514.5Yes2,42054522.51466.01265.2552.334414.2乳腺癌：并发疾病普遍存在a P value 0.05 based on Chi square testc Excludes women who did not undergo surgery (n = 10)高血压，糖尿病，冠心病或中风与高龄，超重（BMI 25- 30 kg / m2）有关放疗和化疗也与高血压、糖尿病、冠心病和中风相关并发疾病影响

15、乳腺癌生存ComorbiditiesCohortRecurrence/metastasisTotal mortalityEventsModel AaModel BbEventsModel AaModel BbHR (95%CI)HR (95%CI)HR (95%CI)HR (95%CI)Specifically assessedcDiabetes288441.10(0.801.52)0.98(0.711.36)671.55(1.182.03)*1.40(1.061.85)*Hypertension1,0451390.91(0.741.12)0.83(0.671.03)1570.88(0.721

16、.07)0.83(0.671.02)CHD232290.81(0.551.21)0.85(0.571.27)360.80(0.561.15)0.80(0.561.15)Stroke101100.60(0.311.15)0.63(0.331.20)231.29(0.832.02)1.42(0.912.22)Chronic bronchitis/asthma268441.13(0.831.54)1.00(0.731.38)471.09(0.811.47)0.96(0.701.30)Chronic gastritis669910.97(0.771.21)1.14(0.911.43)740.74(0.

17、580.94)*0.89(0.691.14)Chronic hepatitis82121.11(0.621.97)1.16(0.652.06)70.60(0.281.26)0.64(0.301.35)* P value 0.05糖尿病与总死亡率风险增加有关并发疾病与乳腺癌生存：来自上海的研究报告comorbiditiesCohortBreast cancer-specific mortalityNon-breast cancer specific mortalityEventsModel AaModel BbEventsModel AaModel BbHR (95%CI)HR (95%CI)H

18、R (95%CI)HR (95%CI)Specifically assessedcDiabetes288361.14(0.801.62)0.98(0.681.41)313.00(1.904.73)*2.64(1.634.27)*Hypertension1,0451100.87(0.691.09)0.82(0.641.04)470.95(0.621.43)0.92(0.601.41)CHD232200.66(0.411.06)0.64(0.401.03)161.15(0.642.06)1.29(0.702.36)Stroke10180.68(0.331.40)0.78(0.381.62)152.

19、55(1.384.71)*2.52(1.334.78)*Chronic bronchitis/asthma268351.07(0.751.51)0.93(0.651.33)121.17(0.642.13)1.03(0.551.91)Chronic gastritis669620.80(0.611.05)0.99(0.761.31)120.53(0.290.96)*0.55(0.301.01)Chronic hepatitis8260.64(0.291.44)0.70(0.311.59)NAeNAe* P value 0.05 糖尿病和中风病史与非乳腺癌死亡率相关、但与乳腺癌特异性死亡率无关 N

20、HypertensionDiabetesCHDStrokeChronic Gastritisn%n%n%n%n%Age at diagnosis, y502,0931728.2391.930.1430.1422610.850591,37230622.3624.5433.1161.222616.5601,19956747.3a18715.6a18615.5a826.8a21718.1aTNM stagebI1,62236022.2875.4845.2342.128217.4II2,39453022.11476.11134.7482.030512.7III44511024.7378.3a235.2

21、132.94911.0aER/PR statusbER+/PR+2,37953722.61476.21154.8562.434414.5ER+/PR61616827.3437.0386.2162.68614.0ER/PR+3516217.7133.7113.151.45014.3ER/PR1,30426920.6a836.4675.1221.718914.5MastectomycNo3055618.4175.6154.9103.34414.4Yes4,35998922.72716.22175.0912.162514.3ChemotherapyNo35516646.86217.56117.224

22、6.86117.2Yes4,30987920.4a2265.2a1714.0a771.8a60814.1RadiotherapyNo3,12778225.02096.71896.0772.547615.2Yes1,53726317.1a795.1a432.8a241.619312.6aTamoxifen useNo2,24450022.31426.31064.7462.132514.5Yes2,42054522.51466.01265.2552.334414.2BMI (kg/m2)25.03,04748616.01555.11103.6521.746015.125.029.991,36242

23、631.31138.3926.8423.218413.53025513352.2a207.8a3011.8a72.7a259.7a乳腺癌预后患者中运动、BMI和并发疾病的影响诊断后生活方式因素的影响：体重指数（BMI），选择并发疾病（仅限糖尿病，仅高血压，或两者兼有）和极低体力活动（定义为体力活动1.5 MET h /周）在单个模型中以及在多变量模型中与乳腺癌死亡率的影响。Breast Cancer Res Treat. 2016 Feb;155(3):551-7.乳腺癌预后患者中运动、BMI和并发疾病的影响Deaths/NModel 1Model 2Model 3Model 4Body ma

24、ss indexUnderweight (18.5)21/1391.45 (0.832.53)1.41 (0.812.45)Normal (18.524.9)429/3889ReferenceReferenceOverweight (25.029.9)389/31541.07 (0.921.25)1.05 (0.901.22)Obese I (30.034.9)192/14711.10 (0.911.33)1.04 (0.861.27)Obese II (35.0)100/8601.05 (0.831.32)0.95 (0.741.20)ComorbiditiesNone715/6037Ref

25、erenceReferenceDiabetes29/1981.49 (0.992.23)*1.43 (0.952.15)*Hypertension332/28551.12 (0.961.31)1.11 (0.951.30)Hypertension & diabetes55/4231.34 (0.971.85)*1.32 (0.951.84)*Physical activityLow (MET h/week 1.5)274/18651.22 (1.051.42)*1.21 (1.031.41)*Not-low (MET h/week 1.5)857/7648ReferenceReference* p