Wyld L, Garg D K, Kumar I D, Brown H, Reed M W R
Academic Surgical Oncology Unit, University of Sheffield, K Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
Br J Cancer. 2004 Apr 19;90(8):1486-91. doi: 10.1038/sj.bjc.6601742.
Breast cancer-specific mortality is static in older women despite having fallen in younger age groups, possibly due to lack of screening and differences in treatment. This study compared stage and treatment between two cohorts of postmenopausal women (55-69 vs >70 years) in a single cancer network over 6 months. A total of 378 patients were studied (>70: N=167, 55-69 years: N=210). Older women presented with more advanced disease (>70: metastatic/locally advanced 12%, 55-69 years: 3%, P<0.01). Those with operable cancer had a worse prognosis (Nottingham Prognostic Index (NPI) >70: median NPI 4.4, 55-69 years: 4.25, P<0.03). These stage differences were partially explained by higher screening rates in the younger cohort. Primary endocrine therapy was used in 42% of older patients compared with 3% in the younger group (P<0.001). Older women with cancers suitable for breast conservation were more likely to choose mastectomy (>70: 57.5% mastectomy rate vs 55-69 years: 20.6%, P<0.01). Nodal surgery was less frequent in older patients (>70: 6.7% no nodal surgery, 55-69 years: 0.5%, P<0.01) and was more likely to be inadequate (>70: 10.7% <4 nodes excised, 55-69 years: 3.4%, P<0.02). In summary, older women presented with more advanced breast cancer, than younger postmenopausal women and were treated less comprehensively.
尽管年轻女性群体中乳腺癌特异性死亡率有所下降，但老年女性的这一死亡率却保持稳定，这可能是由于缺乏筛查以及治疗差异所致。本研究比较了单一癌症网络中两个绝经后女性队列（55 - 69岁与70岁以上）在6个月内的分期和治疗情况。共研究了378例患者（70岁以上：N = 167，55 - 69岁：N = 210）。老年女性所患疾病更晚期（70岁以上：转移性/局部晚期12%，55 - 69岁：3%，P < 0.01）。可手术切除癌症的患者预后较差（诺丁汉预后指数（NPI）70岁以上：中位NPI 4.4，55 - 69岁：4.25，P < 0.03）。这些分期差异部分可由年轻队列中较高的筛查率来解释。42%的老年患者采用了主要内分泌治疗，而年轻组这一比例为3%（P < 0.001）。适合保乳的老年女性更倾向于选择乳房切除术（70岁以上：乳房切除率57.5%，55 - 69岁：20.6%，P < 0.01）。老年患者进行淋巴结手术的频率较低（70岁以上：6.7%未进行淋巴结手术，55 - 69岁：0.5%，P < 0.01），且手术切除淋巴结不足的可能性更大（70岁以上：10.7%切除淋巴结少于4个，55 - 69岁：3.4%，P < 0.02）。总之，老年女性所患乳腺癌比年轻绝经后女性更晚期，且治疗不够全面。
