Barchielli A, Balzi D
Tuscany Cancer Registry, Epidemiology Unit, Center for Cancer Prevention, Careggi Hospital, Florence, Italy.
Tumori. 2000 Mar-Apr;86(2):119-23. doi: 10.1177/030089160008600202.
The effect of age at diagnosis on the prognosis of breast cancer is still controversial. The study described the variation by age at diagnosis of some clinical-pathologic features and evaluated the relationship between age and survival, taking into account the effect of extent of disease.
The study comprised a large population-based series of 1,182 invasive breast cancers, incident in the period 1985-1986 in the province of Florence.
The proportion of cases without nodal involvement progressively lowered from 59% in the age group < or =39 years to 22% in the age group > or =80 years. The extent of disease was unknown in 14% of cases aged 70-79 years and in 43% of those aged > or =80 years (other age groups: 3%-5%). A lower rate of surgical treatment and axillary surgery were the main reasons for inadequate staging in the elderly. Ten-year observed survival progressively decreased from 71% for age < or =39 years to 12% for age > or =80 years. Ten-year relative survival showed less evident differences, dropping from 72% for age < or =39 years to 57% for age > or =80 years. In the relative survival analysis, the differences in relative risks of death among age groups were not significant, either in the univariate or multivariate analysis. Nevertheless, the model with adjustment for extension of disease showed a flattening of the estimated relative risks in age groups over 59 years.
Age at diagnosis was not significantly related to 10-year breast cancer relative survival, suggesting that the worse prognosis in the elderly was largely related to the risk of death from other causes, rather than to a different malignant potential of the tumor. The worse distribution by extent of disease in older women indirectly suggested that diagnostic delays also influenced the different prognosis observed among age groups.
确诊年龄对乳腺癌预后的影响仍存在争议。本研究描述了某些临床病理特征在确诊年龄方面的差异，并在考虑疾病范围影响的情况下，评估了年龄与生存之间的关系。
本研究纳入了1985 - 1986年期间佛罗伦萨省基于人群的1182例浸润性乳腺癌大样本系列。
无淋巴结受累病例的比例从年龄≤39岁组的59%逐渐降至年龄≥80岁组的22%。在70 - 79岁的病例中，14%的病例疾病范围未知，而在年龄≥80岁的病例中这一比例为43%（其他年龄组为3% - 5%）。手术治疗率和腋窝手术率较低是老年患者分期不充分的主要原因。观察到的10年生存率从年龄≤39岁组的71%逐渐降至年龄≥80岁组的12%。10年相对生存率的差异不太明显，从年龄≤39岁组的72%降至年龄≥80岁组的57%。在相对生存分析中，单因素或多因素分析中各年龄组死亡相对风险的差异均不显著。然而，对疾病范围进行调整的模型显示，59岁以上年龄组的估计相对风险趋于平缓。
确诊年龄与10年乳腺癌相对生存率无显著相关性，这表明老年人预后较差主要与其他原因导致的死亡风险有关，而非肿瘤不同的恶性潜能。老年女性疾病范围分布较差间接表明，诊断延迟也影响了各年龄组观察到的不同预后。
