英国牛津大学Carolyn Taylor团队研究了1993-2015年英国早期浸润性乳腺癌女性的癌症死亡率。相关论文发表在2023年6月14日出版的《英国医学杂志》上。

为了描述过去被诊断为乳腺癌女性的长期乳腺癌症死亡率，并估计最近被诊断为癌症患者组的绝对乳腺癌死亡风险，研究组定期从国家癌症登记和分析服务机构收集数据，进行了一项基于人群的观察性队列研究。

1993年1月至2015年12月，英国512447名女性登记患有早期浸润性乳腺癌（仅涉及乳腺和可能的腋窝淋巴结），并于2020年12月进行随访。主要结局为自诊断以来，癌症的年死亡率和累积风险，诊断日历时间，以及患者和肿瘤的九个特征。

对于在1993-99年、2000-04年、2005-09年和2010-15年各日历期内诊断出乳腺癌的女性，乳腺癌粗死亡率在诊断后的五年内最高，随后有所下降。自诊断以来的任何一段时间内，每年乳腺癌症的粗死亡率和风险都会随着日历周期的增加而降低。1993年至1999年期间诊断出乳腺癌的女性五年粗死亡率为14.4%，2010年至2015年期间诊断为乳腺癌的妇女五年粗死亡风险为4.9%。

在几乎每个患者组中，校正后的年度乳腺癌症死亡率也随着日历周期的增加而降低，雌激素受体阳性疾病降低了大约三倍，雌激素受体阴性疾病降低了约两倍。仅考虑2010-15年间诊断出乳腺癌的女性，不同特征的女性五年累积乳腺癌死亡率差异很大：从62.8%的女性小于3%，到4.6%的女性超过20%不等。

研究结果表明，最近确诊的患者的五年乳腺癌症死亡风险可用于评估当今患者的乳腺癌死亡风险。自20世纪90年代以来，早期浸润性癌症患者的预后显著改善。大多数人有望成为癌症的长期幸存者，尽管对少数人来说，风险仍然很大。

附：英文原文

Title: Breast cancer mortality in 500000 women with early invasive breast cancer in England, 1993-2015: population based observational cohort study

Author: Carolyn Taylor, Paul McGale, Jake Probert, John Broggio, Jackie Charman, Sarah C Darby, Amanda J Kerr, Timothy Whelan, David J Cutter, Gurdeep Mannu, David Dodwell

Issue&Volume: 2023/06/13

Abstract:

Objectives To describe long term breast cancer mortality among women with a diagnosis of breast cancer in the past and estimate absolute breast cancer mortality risks for groups of patients with a recent diagnosis.

Design Population based observational cohort study.

Setting Routinely collected data from the National Cancer Registration and Analysis Service.

Participants All 512447 women registered with early invasive breast cancer (involving only breast and possibly axillary nodes) in England during January 1993 to December 2015, with follow-up to December 2020.

Main outcome measures Annual breast cancer mortality rates and cumulative risks by time since diagnosis, calendar period of diagnosis, and nine characteristics of patients and tumours.

Results For women with a diagnosis made within each of the calendar periods 1993-99, 2000-04, 2005-09, and 2010-15, the crude annual breast cancer mortality rate was highest during the five years after diagnosis and then declined. For any given time since diagnosis, crude annual breast cancer mortality rates and risks decreased with increasing calendar period. Crude five year breast cancer mortality risk was 14.4% (95% confidence interval 14.2% to 14.6%) for women with a diagnosis made during 1993-99 and 4.9% (4.8% to 5.0%) for women with a diagnosis made during 2010-15. Adjusted annual breast cancer mortality rates also decreased with increasing calendar period in nearly every patient group, by a factor of about three in oestrogen receptor positive disease and about two in oestrogen receptor negative disease. Considering just the women with a diagnosis made during 2010-15, cumulative five year breast cancer mortality risk varied substantially between women with different characteristics: it was <3% for 62.8% (96085/153006) of women but ≥20% for 4.6% (6962/153006) of women.

Conclusions These five year breast cancer mortality risks for patients with a recent diagnosis may be used to estimate breast cancer mortality risks for patients today. The prognosis for women with early invasive breast cancer has improved substantially since the 1990s. Most can expect to become long term cancer survivors, although for a few the risk remains appreciable.

DOI: 10.1136/bmj-2022-074684

Source: https://www.bmj.com/content/381/bmj-2022-074684