Bouchardy Christine, Rapiti Elisabetta, Fioretta Gérald, Laissue Paul, Neyroud-Caspar Isabelle, Schäfer Peter, Kurtz John, Sappino André-Pascal, Vlastos Georges
Geneva Cancer Registry, 55 Boulevard de la Cluse 55, 1205 Geneva, Switzerland.
J Clin Oncol. 2003 Oct 1;21(19):3580-7. doi: 10.1200/JCO.2003.02.046. Epub 2003 Aug 11.
No consensus exists on therapy of elderly cancer patients. Treatments are influenced by unclear standards and are usually less aggressive. This study aims to evaluate determinants and effect of treatment choice on breast cancer prognosis among elderly patients.
We reviewed clinical files of 407 breast cancer patients aged >/= 80 years recorded at the Geneva Cancer Registry between 1989 and 1999. Patient and tumor characteristics, general health status, comorbidity, treatment, and cause of death were considered. We evaluated determinants of treatment by logistic regression and effect of treatment on mortality by Cox model, accounting for prognostic factors.
Age was independently linked to the type of treatment. Overall, 12% of women (n = 48) had no treatment, 32% (n = 132) received tamoxifen only, 7% (n = 28) had breast-conserving surgery only, 33% (n = 133) had mastectomy, 14% (n = 57) had breast-conserving surgery plus adjuvant therapy, and 2% (n = 9) received miscellaneous treatments. Five-year specific breast cancer survival was 46%, 51%, 82%, and 90% for women with no treatment, tamoxifen alone, mastectomy, and breast-conserving surgery plus adjuvant treatment, respectively. Compared with the nontreated group, the adjusted hazard ratio of breast cancer mortality was 0.4 (95% CI, 0.2 to 0.7) for tamoxifen alone, 0.4 (95% CI, 0.1 to 1.4) for breast-conserving surgery alone, 0.2 (95% CI, 0.1 to 0.7) for mastectomy, and 0.1 (95% CI, 0.03 to 0.4) for breast-conserving surgery plus adjuvant treatment.
Half of elderly patients with breast cancer are undertreated, with strongly decreased specific survival as a consequence. Treatments need to be adapted to the patient's health status, but also should offer the best chance of cure.
老年癌症患者的治疗尚无共识。治疗受到不明确标准的影响，通常不够积极。本研究旨在评估老年乳腺癌患者治疗选择的决定因素及其对预后的影响。
我们回顾了1989年至1999年在日内瓦癌症登记处记录的407例年龄≥80岁的乳腺癌患者的临床档案。考虑了患者和肿瘤特征、总体健康状况、合并症、治疗情况及死亡原因。我们通过逻辑回归评估治疗的决定因素，并通过Cox模型评估治疗对死亡率的影响，同时考虑预后因素。
年龄与治疗类型独立相关。总体而言，12%（n = 48）的女性未接受治疗，32%（n = 132）仅接受他莫昔芬治疗，7%（n = 28）仅接受保乳手术，33%（n = 133）接受乳房切除术，14%（n = 57）接受保乳手术加辅助治疗，2%（n = 9）接受其他治疗。未接受治疗、仅接受他莫昔芬治疗、接受乳房切除术以及接受保乳手术加辅助治疗的女性，其乳腺癌5年特异性生存率分别为46%、51%、82%和90%。与未治疗组相比，仅接受他莫昔芬治疗的患者乳腺癌死亡校正风险比为0.4（95%CI，0.2至0.7），仅接受保乳手术的患者为0.4（95%CI，0.1至1.4），接受乳房切除术的患者为0.2（95%CI，0.1至0.7），接受保乳手术加辅助治疗的患者为0.1（95%CI，0.03至0.4）。
一半的老年乳腺癌患者治疗不足，导致特异性生存率大幅下降。治疗需要根据患者的健康状况进行调整，但也应提供最佳的治愈机会。
