Hormone Therapy and its Effect on the Prognosis in Breast Cancer Patients

Abstract

Introduction: Use of hormone therapy (HT) has declined dramatically in recent years. Some studies have reported that HT use before a diagnosis of breast cancer (BC) may be a prognostic factor in postmenopausal patients. This study aimed to examine the prognostic relevance of HT use before BC diagnosis.

Methods: Four BC cohort studies in Germany were pooled, and 4492 postmenopausal patients with HT use data were identified. Patient data and tumor characteristics were compared between users and nonusers, along with overall survival (OS), distant metastasis-free survival (DMFS), and local recurrence-free survival (LRFS). Cox proportional hazards models were stratified by study center and adjusted for age at diagnosis, tumor stage, grading, nodal status, and hormone receptors.

Results: Women with HT use before the diagnosis of BC were more likely to have a lower tumor stage, to be estrogen receptor–negative, and to have a lower grading. With regard to prognosis there were effects seen for OS, DMFS and LRFS, specifically in the subgroup of women with a positive hormone receptor. In these subgroups, BC patients had a better prognosis with previous HT use.

Conclusions: HT use before a diagnosis of BC is associated with a more favorable prognosis in women with a positive hormone receptor status. It may be recommended that the prognostic factor HT should be documented and analyzed as a confounder for prognosis in studies of postmenopausal hormone-responsive breast cancers.

Zusammenfassung

Einleitung: Der Einsatz einer menopausalen Hormonersatztherapie (HT) hat in den letzten Jahren deutlich abgenommen. Einige kleinere Studien konnten zeigen, dass der Gebrauch vor der Diagnose eines Brustkrebses (BC) ein prognostischer Faktor bei postmenopausalen Patientinnen darstellt. Ziel dieser Studie ist es, die prognostische Relevanz des Hormontherapie-Gebrauchs vor Brustkrebsdiagnose zu untersuchen. Methoden: Vier Kohortenstudien mit Brustkrebspatientinnen aus Deutschland wurden zusammengefügt, und 4492 postmenopausale Patientinnen, zu denen Daten zum HT Gebrauch vorliegen, konnten identifiziert werden. Patientinnen- und Tumorcharakteristika wurden zwischen Patientinnen mit HT zum Diagnosezeitpunkt und Patientinnen ohne HT-Einnahme zum Diagnosezeitpunkt verglichen, zusätzlich das Gesamtüberleben (OS), das fernmetastasenfreie Überleben (DMFS) und das lokalrezidivfreie Überleben (LRFS). Cox-Modelle wurden nach Studienzentren stratifiziert und für Alter bei Diagnose, Tumorstadium, Grading, Nodalstatus und Hormonrezeptorstatus adjustiert. Ergebnisse: Patientinnen, welche eine HT vor Brustkrebsdiagnose eingenommen hatten, wurden eher mit einem niedrigeren Tumorstadium, einem östrogenrezeptornegativen Tumor und einem niedrigeren Grading diagnostiziert. In Bezug auf die Prognose konnten Effekte bezüglich des OS, DMFS und LRFS, im speziellen in der Subgruppe der Frauen mit einem hormonrezeptorpositiven Tumor gezeigt werden. In diesen Subgruppen hatten Brustkrebspatientinnen, welche zuvor eine HT eingenommen hatten, eine bessere Prognose.

Key words

breast cancer - hormone therapy - hormone receptors - prognosis

Schlüsselwörter

Brustkrebs - Hormontherapie - Hormonrezeptoren - Prognose

^* These authors contributed equally to this study.

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