Prognostic Impact of Comorbidity among Long-Term Breast Cancer Survivors: Results from the LACE Study
Menée sur une cohorte de 2 272 femmes atteintes d'un cancer du sein (durée médiane de suivi : 9 ans), cette étude prospective évalue l'association entre l'indice de comorbidité de Charlson, l'hypertension et la survie des patientes
Background: Little is known about the long-term impact of comorbidity among women with breast cancer. Methods : We studied a prospective cohort of 2272 women with breast cancer, who were recruited following initial breast cancer treatment. Associations of the Charlson Comorbidity Index (CCI) and hypertension with survival were evaluated in delayed entry Cox proportional hazards models. Results: During a median follow-up of nine years, higher CCI scores were independently associated with an increased risk of death from all causes (hazard ratio [HR] = 1.32, 95% confidence interval [CI] = 1.13 to 1.54) and from non-breast cancer causes (HR = 1.55, 95% CI = 1.19 to 2.02), but not from breast cancer (HR = 1.14, 95% CI = 0.93 to 1.41). Hypertension was independently associated with an increased risk of death from all causes (HR = 1.55, 95% CI = 1.20 to 1.99), from non-breast cancer causes (HR = 1.67, 95% CI = 1.10 to 2.54) and from breast cancer (HR = 1.47, 95% CI = 1.03 to 2.09), but these associations were no longer significant after adjustment for antihypertensive medication. The relationship between the CCI and overall survival was the strongest among women with stage I disease (stage I, HR = 1.65, 95% CI = 1.26 to 2.16 vs. stage III, HR = .53, 95% CI = .23 to 1.25). Conclusion: The CCI was independently associated with lower overall and non-breast cancer survival but not with breast cancer-specific survival. Impact: Comorbidity may play an important role in breast cancer outcomes.
Cancer Epidemiology Biomarkers & Prevention , résumé, 2012