PO.PS01.10 · 人群科学
波多黎各乳腺癌生存者的心血管疾病死亡率：一项基于人群的竞争风险分析
Cardiovascular disease mortality among breast cancer survivors in Puerto Rico: A population-based competing risk analysis
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
目的：心血管疾病（CVD）是乳腺癌（BC）生存者日益重要的死因，但在波多黎各，竞争性死亡风险仍研究不足。本研究采用竞争风险方法，估算了波多黎各乳腺癌生存者中BC特异性和CVD特异性死亡的累积发生率，并识别相关危险因素。
方法：分析了波多黎各中央癌症登记处（Puerto Rico Central Cancer Registry，2004–2019年）中登记的17,430名女性BC患者的数据，这些患者在诊断后存活至少1年，并随访至2021年。死亡被分类为BC相关或CVD相关。采用Fine-Gray竞争风险模型估算亚分布风险比（HR）及95%置信区间，并按年龄组（18–64岁、65–79岁、80岁及以上）分层，以评估诊断后5年、10年和15年时BC和CVD死亡的人口学和临床相关因素。
结果：在17,430名生存者中，6,881名（39.5%）在随访期间死亡。BC是主要死因（3,636例死亡；52.8%），而470例（6.8%）死于CVD。死于CVD者的中位生存期（5.5年（IQR：3.1，8.7））长于死于BC者（3.6年（IQR：2.2，5.9））。至诊断后15年，CVD已成为主要竞争风险：在80岁及以上女性中，CVD死亡的累积发生率达到14.5%（95% CI：9.3，19.4），接近BC死亡风险16.6%（95% CI：12.4，20.6）。在较年轻的生存者（18–64岁）中，合并症显著增加CVD死亡风险（HR=2.7，95% CI：1.5，4.8），但与BC死亡无关（HR=1.0，95% CI：0.9，1.2）。晚期分期和侵袭性治疗方式在各年龄组中始终与更高的BC死亡相关，而合并症和高龄是CVD死亡的关键驱动因素。
结论：尽管BC仍是生存者的主要死因，但CVD成为一项重要的竞争风险，尤其是在生存期延长的老年女性中。不同的风险特征——如合并症对较年轻生存者CVD死亡的强烈影响，以及80岁及以上年龄组中BC与CVD死亡差距的缩小——凸显了需要建立将癌症监测与心血管管理相结合的生存者照护模式。
查看英文原文 English abstract
Purpose: Cardiovascular disease (CVD) is an increasingly important cause of death among breast cancer (BC) survivors, yet competing mortality risks remain understudied in Puerto Rico. This study estimated the cumulative incidence of BC-specific and CVD-specific mortality and identified associated risk factors among Puerto Rican BC survivors using competing risk methodology.
Methods: Data were analyzed from 17,430 female BC patients recorded in the Puerto Rico Central Cancer Registry (2004-2019) who survived at least 1 year post-diagnosis and were followed through 2021. Deaths were categorized as BC- or CVD-related. Fine-Gray competing risk models estimated subdistribution hazard ratios (HRs) with 95% confidence intervals, stratified by age group (18-64, 65-79, 80+), to evaluate demographic and clinical correlates of BC and CVD mortality at 5, 10, and 15 years post-diagnosis.
Results: Among 17,430 survivors, 6,881 (39.5%) died during follow-up. BC was the leading cause of death (3,636 deaths; 52.8%), while 470 (6.8%) were due to CVD. Median survival was longer among those who died from CVD (5.5 years (IQR: 3.1, 8.7)) than from BC (3.6 years (IQR: 2.2, 5.9)). By 15 years post-diagnosis, CVD had become a major competing risk: among women aged 80+, the cumulative incidence of CVD mortality reached 14.5% (95% CI: 9.3, 19.4), approaching the BC mortality risk of 16.6% (95% CI: 12.4, 20.6). In younger survivors (ages 18-64), comorbidity significantly increased CVD mortality risk (HR=2.7, 95% CI: 1.5, 4.8) but was not associated with BC mortality (HR=1.0, 95% CI: 0.9, 1.2). Advanced stage and aggressive treatment modalities were consistently associated with greater BC mortality across age groups, while comorbidity and older age were key drivers of CVD mortality.
Conclusions: While BC remains the primary cause of death among survivors, CVD emerges as a substantial competing risk, especially in older women with extended survivorship. Distinct risk profiles, such as the strong influence of comorbidities on CVD mortality in younger survivors and the narrowing difference between BC and CVD mortality in the 80+ age group, underscore the need for survivorship care models that integrate cancer surveillance and cardiovascular management.
利益披露 Disclosure
G. Rodríguez-Ortiz, None..
B. Segarra-Vasquez, DHSc, None..
F. Córdova-Pérez, None..
V. Colón-López, None..
C. T. Sánchez-Díaz, None.