Effect of glucocorticoid use on survival in patients with stage I–III breast cancer
- 181 Downloads
Glucocorticoids (GCs) are commonly used in breast cancer patients to ameliorate emesis induced by chemotherapy. Some preclinical studies have suggested that systemic GCs might promote survival of estrogen receptor (ER)-negative breast cancer cells. This study aims to clarify their clinical effect on patient survival.
A total of 18,596 women with newly diagnosed stage I–III breast cancer in 2002–2006 were identified from the Taiwan Cancer Database and drug treatment was examined from the Taiwan National Health Insurance Claims Database. Of these, 3989 who did not receive adjuvant chemotherapy (non-chemotherapy cohort) and 3237 patients who received six cycles of adjuvant anthracycline-based chemotherapy (anthracycline cohort) were included. The impact of GC use on survival was analyzed separately in these two cohorts using Cox proportional hazards models.
In the non-chemotherapy cohort, GC use was associated with aggressive clinicopathological features of breast cancer. High-dose GC was associated with shorter overall survival in univariate analysis but not in multivariate analysis. In the anthracycline cohort, multivariate analysis showed that GC use at each dose level was significantly associated with longer breast cancer-specific survival (HR 0.65, 0.70, and 0.70 for low-dose, median-dose, and high-dose GC, respectively) and overall survival (HR 0.72, 0.76, and 0.73, respectively) when compared with those receiving no GC. The associations were significant in both ER-positive and ER-negative subgroups for breast cancer-specific survival, and in ER-negative subgroup for overall survival.
Concomitant use of GC improved survival in patients receiving adjuvant anthracycline-based chemotherapy for stage I–III breast cancer.
KeywordsGlucocorticoid Breast cancer Adjuvant chemotherapy Survival
This study was supported by grants from the National Science Council, Taiwan (Grant NSC 99-2410-H-038-004); the National Center of Excellence for Clinical Trial and Research, Taiwan (Grant Number MOHW105-TDU-B-211-134005); and the Ministry of Science and Technology, ROC. (MOST 105-2911-I-002-302). The funding source had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data, writing assistance, or decision to submit results.
Compliance with ethical standards
Conflict of interest
No potential conflicts of interest exist.
- 14.Ingle JN, Mailliard JA, Schaid DJ et al (1991) A double-blind trial of tamoxifen plus prednisolone versus tamoxifen plus placebo in postmenopausal women with metastatic breast cancer. A collaborative trial of the North Central Cancer Treatment Group and Mayo Clinic. Cancer 68:34–39CrossRefPubMedGoogle Scholar
- 15.Cocconi G, Bisagni G, Ceci G et al (1992) Low-dose aminoglutethimide with and without hydrocortisone replacement as a first-line endocrine treatment in advanced breast cancer: a prospective randomized trial of the Italian Oncology Group for Clinical Research. J Clin Oncol 10:984–989CrossRefPubMedGoogle Scholar
- 17.Tormey DC, Gray R, Gilchrist K et al (1990) Adjuvant chemohormonal therapy with cyclophosphamide, methotrexate, 5-fluorouracil, and prednisone (CMFP) or CMFP plus tamoxifen compared with CMF for premenopausal breast cancer patients. An Eastern Cooperative Oncology Group trial. Cancer 65:200–206CrossRefPubMedGoogle Scholar
- 27.Hu C (1999) Steroid equivalence converter. http://www.medcalc.com/steroid.html
- 29.DiMartino L, Demontis B, Mitchell IP et al (1991) A randomized clinical trial to investigate the usefulness of the addition of prednisolone to tamoxifen as adjuvants to mastectomy in primary breast cancer patients with a high risk of recurrence: a preliminary report. Anticancer Res 11:869–872PubMedGoogle Scholar