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Competing risks of death in younger and older postmenopausal breast cancer patients

World Journal of Clinical Oncology 2014年第5期5卷 1088-1096页

作者： Judy-Anne W Chapman Kathleen I Pritchard Paul E Goss James N Ingle Hyman B Muss susan f dent Ted A Vandenberg Brian findlay Karen A Gelmon Carolyn f Wilson Lois E Shepherd Michael N Pollak NCIC Clinical Trials Group Queen's University Kingston ON K7L 3N6 Canada Sunnybrook Odette Cancer Centre University of Toronto Toronto ON M4N 3M5 Canada Massachusetts General Hospital Harvard University Boston MA 02114 United States Mayo Clinic Rochester MN 55902 United States Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill Chapel Hill NC27514 United States Ottawa Hospital Cancer Center University of Ottawa Ottawa ON K1H8L6 Canada London Health Sciences Centre University of Western Ontario London ON N6G 2V4 Canada Niagara Health System McM aster University St. Catharines ON L2R 2Z4 Canada BC Cancer Agency University of British Columbia Vancouver BC V5Z 1L3 Canada NCIC Clinical Trials Group Queen's University Kingston Ontario K7L 3N6 Canada Lady Davis Institute Jewish General Hospital McG ill University Montreal QC H3T 1E2 Canada

AIM: To show a new paradigm of simultaneously testing whether breast cancer therapies impact other causes of death. METHODS: MA.14 allocated 667 postmenopausal women to 5 years of tamoxifen 20 mg/daily ± 2 years of octreotide 90 mg, given by depot intramuscular injections monthly. Event-free survival was the primary endpoint of MA.14; at median 7.9 years, the tamoxifen+octreotide and tamoxifen arms had similar event-free survival(P = 0.62). Overall survival was a secondary endpoint, and the two trial arms also had similar overall survival(P = 0.86). We used the median 9.8 years follow-up to examine by intention-to-treat, the multivariate time-to-breast cancer-specific(Br Ca) and other cause(OC) mortality with log-normal survival analysis adjusted by treatment and stratification factors. We tested whether baseline factors including Insulin-like growth factor 1(IGf1), IGf binding protein-3, C-peptide, body mass index, and 25-OH vitamin D were associated with(1) all cause mortality, and if so; and(2) cause-specific mortality. We also fit step-wise forward cause-specific adjusted ***: The analyses were performed on 329 patients allocated tamoxifen and 329 allocated tamoxifen+octreotide. The median age of MA.14 patients was 60.1 years: 447(82%) f which 24 were other malignancies, 31 other causes of death; 9(5.3%) patients with unknown cause of death were excluded from competing risk assessments. BrC a and OC deaths were not significantly different by treatment arm(P = 0.40): tamoxifen patients experienced 50 BrC a and 32 OC deaths, while tamoxifen + octreotide patients experienced 56 Br Ca and 23 OC deaths. Proportionately more deaths(P = 0.004) were from BrC a for patientsf deaths were due to Br Ca, compared to 54% for those ≥ 70 years of age. The proportion of deaths from OC increased with increasing body mass index(BMI)(P = 0.02). Higher pathol

关键词： Breast cancer Postmenopausal Hormone receptor positive Competing risks Tamoxifen Octreotide LAR

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