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Abstract：
BACKGROUND: Evidence suggests that women with breast cancer diagnosed during pregnancy (PrBC) and within 2 years of delivery (PPBC) have similar survival compared to women diagnosed not near pregnancy if adjusted for stage and subtype. To investigate whether this is true for all subtypes and for both pregnancy and post-delivery periods, we examined clinicopathologic features and survival in women with breast cancer by trimesters and 6-month post-delivery intervals.
METHODS: Women diagnosed with invasive breast cancer during 1992-2018 at ages 18-44 years were identified in the Swedish Cancer Register, with information on childbirths from the Swedish Multi-Generation Register and clinical data from Breast Cancer Quality Registers. Each woman with PrBC or PPBC was matched 1 : 2 by age and year to comparators diagnosed with breast cancer not near pregnancy. Distributions of stage, grade, and surrogate subtypes were compared. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for breast cancer mortality were estimated using Cox regression.
RESULTS: We identified 1430 women with PrBC and PPBC (181 during pregnancy, 499 during the first and 750 during the second year after delivery). Compared to 2860 comparators, women with PrBC and PPBC in the first year after delivery had a significantly higher proportion of luminal human epidermal growth factor receptor 2 (HER2)-positive, HER2-positive and triple-negative tumours, and more advanced stage at diagnosis. After adjustment for age, year, parity, country of birth, hospital region, subtype, and stage, women diagnosed during the second trimester had a worse prognosis than matched comparators (HR 1.8, 95% CI: 1.0-3.2).
CONCLUSIONS: Women diagnosed during pregnancy or within the first year after delivery have a worse prognosis than women diagnosed not near pregnancy due to adverse tumour biology and advanced stage at diagnosis. A worse prognosis for women diagnosed during the second trimester remained after multivariable adjustment, possibly reflecting difficulties to provide optimal treatment during ongoing pregnancy.
METHODS: Women diagnosed with invasive breast cancer during 1992-2018 at ages 18-44 years were identified in the Swedish Cancer Register, with information on childbirths from the Swedish Multi-Generation Register and clinical data from Breast Cancer Quality Registers. Each woman with PrBC or PPBC was matched 1 : 2 by age and year to comparators diagnosed with breast cancer not near pregnancy. Distributions of stage, grade, and surrogate subtypes were compared. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for breast cancer mortality were estimated using Cox regression.
RESULTS: We identified 1430 women with PrBC and PPBC (181 during pregnancy, 499 during the first and 750 during the second year after delivery). Compared to 2860 comparators, women with PrBC and PPBC in the first year after delivery had a significantly higher proportion of luminal human epidermal growth factor receptor 2 (HER2)-positive, HER2-positive and triple-negative tumours, and more advanced stage at diagnosis. After adjustment for age, year, parity, country of birth, hospital region, subtype, and stage, women diagnosed during the second trimester had a worse prognosis than matched comparators (HR 1.8, 95% CI: 1.0-3.2).
CONCLUSIONS: Women diagnosed during pregnancy or within the first year after delivery have a worse prognosis than women diagnosed not near pregnancy due to adverse tumour biology and advanced stage at diagnosis. A worse prognosis for women diagnosed during the second trimester remained after multivariable adjustment, possibly reflecting difficulties to provide optimal treatment during ongoing pregnancy.
摘要：
背景：证据表明，如果调整分期和亚型，与被诊断为未接近妊娠的女性相比，在妊娠期间（PrBC）和分娩后2年内（PPBC）诊断为乳腺癌的女性具有相似的生存率。为了调查这是否适用于所有亚型以及妊娠和产后，我们研究了乳腺癌女性的临床病理特征和生存情况,分别为妊娠3个月和分娩后6个月.
方法：在1992-2018年期间被诊断为浸润性乳腺癌的女性，年龄在18-44岁之间。来自瑞典多代登记的分娩信息和来自乳腺癌质量登记的临床数据。每个患有PrBC或PPBC的女性在年龄和年份上与未接近妊娠的诊断为乳腺癌的比较者匹配1：2。舞台的分布，grade,和替代亚型进行了比较。使用Cox回归估计乳腺癌死亡率的调整风险比（HR）和95％置信区间（CI）。
结果：我们确定了1430名患有PrBC和PPBC的女性（怀孕期间181名，交付后的第一年为499，第二年为750）。与2860个比较器相比，在分娩后的第一年，患有PrBC和PPBC的女性在腔内人表皮生长因子受体2（HER2）阳性的比例明显更高，HER2阳性和三阴性肿瘤，更高级的诊断阶段。调整后的年龄，Year,奇偶校验，出生国,医院区域,子类型,舞台,在妊娠中期诊断的女性的预后比匹配的比较者差(HR1.8,95%CI:1.0~3.2).
结论：由于不良的肿瘤生物学和诊断晚期，在妊娠期间或分娩后第一年内诊断的妇女的预后比诊断为未接近妊娠的妇女差。在多变量调整后，在妊娠中期诊断的女性预后较差，可能反映了在持续怀孕期间提供最佳治疗的困难。
方法：在1992-2018年期间被诊断为浸润性乳腺癌的女性，年龄在18-44岁之间。来自瑞典多代登记的分娩信息和来自乳腺癌质量登记的临床数据。每个患有PrBC或PPBC的女性在年龄和年份上与未接近妊娠的诊断为乳腺癌的比较者匹配1：2。舞台的分布，grade,和替代亚型进行了比较。使用Cox回归估计乳腺癌死亡率的调整风险比（HR）和95％置信区间（CI）。
结果：我们确定了1430名患有PrBC和PPBC的女性（怀孕期间181名，交付后的第一年为499，第二年为750）。与2860个比较器相比，在分娩后的第一年，患有PrBC和PPBC的女性在腔内人表皮生长因子受体2（HER2）阳性的比例明显更高，HER2阳性和三阴性肿瘤，更高级的诊断阶段。调整后的年龄，Year,奇偶校验，出生国,医院区域,子类型,舞台,在妊娠中期诊断的女性的预后比匹配的比较者差(HR1.8,95%CI:1.0~3.2).
结论：由于不良的肿瘤生物学和诊断晚期，在妊娠期间或分娩后第一年内诊断的妇女的预后比诊断为未接近妊娠的妇女差。在多变量调整后，在妊娠中期诊断的女性预后较差，可能反映了在持续怀孕期间提供最佳治疗的困难。
