Prognosis for patients diagnosed with pregnancy-associated breast cancer: a paired case-control study

Abstract

CONTEXT AND OBJECTIVE: Previous studies have suggested that the occurrence of pregnancy concomitantly with a diagnosis of breast cancer may affect the evolution of the neoplasia. The present study aimed to compare pregnancy-associated breast cancer (PABC) patients with non-pregnant cancer patients (controls) in relation to the time taken to diagnose the disease, tumor characteristics and mortality. DESIGN AND SETTING:A retrospective, paired case-control study was conducted at the Hospital da Santa Casa de Misericórdia and Centro de Quimioterapia Antiblástica e Imunoterapia in Belo Horizonte, Brazil. METHODS:The study involved 87 PABC and 252 control patients. The influence of covariables (interval between first symptoms and diagnosis, tumor histology, size of primary tumor, distant metastasis, grade of malignancy, hormone receptor status and axillary lymph node involvement) and the pregnancy variable on overall survival was investigated using univariate and multivariate analyses. RESULTS:The median overall survival for PABC patients of 30.1 months (95% confidence interval, CI: 19.4-40.9 months) was significantly different (P = 0.005) from that of the control group (53.1 months; 95% CI: 35.1-71.0 months). The cumulative overall survivals after five and ten years were, respectively, 29.7 and 19.2% for PABC patients, and 47.3 and 34.8% for control patients (P = 0.005). Tumor size, grade of malignancy, distant metastasis and pregnancy were independent factors that significantly modified disease prognosis. CONCLUSIONS:Pregnancy was an independent prognostic factor. The overall survival of PABC patients was shorter than that of non-pregnant patients.RESUMO CONTEXTO E OBJETIVO: Estudos prévios sugerem que a ocorrência de gravidez simultaneamente com o diagnóstico de câncer de mama pode afetar a evolução da neoplasia. O presente estudo objetivou comparar pacientes com câncer de mama associado à gravidez (PABC) e pacientes com câncer não grávidas (controles) com relação ao tempo decorrido até o diagnóstico de câncer, características tumorais e mortalidade. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo, tipo caso-controle pareado, foi conduzido no Hospital da Santa Casa de Misericórdia e Centro deQuimioterapia Antiblástica e Imunoterapia em Belo Horizonte, Brasil. MÉTODOS:O estudo envolveu 87 pacientes PABC e 252 controles. A influência das covariáveis (intervalo entre os primeiros sintomas e diagnóstico, histologia do tumor, tamanho do tumor primário, metástase a distância, grau de malignidade, dosagem de receptor hormonal e acometimento dos linfonodos axilares) e da variável gravidez sobre a sobrevida global foram avaliados através de análises univariada e multivariada. RESULTADOS:A mediana da sobrevida global para as pacientes PABC de 30,1 meses (intervalo de confiança, IC 95%: 19,4-40,9 meses) foi significativamente (P = 0,005) diferente daquela dos controles (53,1 meses; IC 95%: 35,1-71,0 meses). A sobrevida global acumulada após 5 e 10 anos foi 29,7 e 19,2% no grupo PABC e 47,3 e 34,8% nos controles. Tamanho...

Does Pregnancy-Associated Breast Cancer Imply a Worse Prognosis? A Matched Case-Case Study

“…Moreover, our results are in accordance with those recently published by Azim et al [18]; in this well designed case-control study, PABC patients exhibited a poorer prognosis compared to age- and stage-matched controls, whilst there was no difference in tumor features between the 2 groups. In addition, our study seems in accordance with numerous unmatched studies which pointed through multivariate adjustment to an independent role of pregnancy, controlling for stage [19,20,21]. On the other hand, apart from smaller studies, the present report is in line with a recent population-based cohort study by Johansson et al including 15,721 women, which essentially confirmed the findings regarding pregnancy in a large population sample [24]; however, it should be stressed that the authors did not provide any data regarding prognostic parameters of the breast cancers.…”

“…Many studies did not suggest any significant associations [7,8,9,10,11,12,13], whereas others attributed any detrimental effects solely on the delayed diagnosis of tumors in pregnancy [14,15,16,17,18]. On the contrary, some studies pointed to the opposite direction, indicating an independent poor prognostic role of pregnancy [19,20,21]. From a methodological point of view, the aforementioned may imply that the elucidation of the effects mediated by pregnancy may to a certain extent be challenging, as the advanced stage of tumors diagnosed during pregnancy seems to represent a confounding factor.…”

Clinicopathological Features and Prognosis of Pregnancy Associated Breast Cancer – A Matched Case Control Study

“…As far as outcome of PABC is concerned data are conflicting: some authors showed no difference in outcome of PABC and non-PABC cases [14,16,24], while others consider PABC as having unfavorable prognosis [1,[7][8][9]. In a recent metaanalysis of 30 studies, Azim et al found that PABC patients had poor overall survival especially if breast cancer was diagnosed within 1 year postpartum [25].…”

“…The prognosis of PABC is more often reported as being unfavorable [1,[7][8][9][10]. Whether this poor prognosis is related to pregnancy or mainly due to the young age of patientswhich in itself is known to be a poor prognostic factor [11] -is not clear.…”

Outcome of Patients with Pregnancy during or after Breast Cancer: A Review of the Recent Literature

“…Therapeutic abortion was a response to the belief that the hormonal milieu of pregnancy resulted in the poor outcome. Some studies indicate that prognosis in advanced-stage cancer is worse in the pregnancy-associated group than in a stage-matched nonpregnant group 15,48 , especially for women more than 35 years of age and for those diagnosed within 1 year postpartum 20,21,24,28,53 .…”