Gennari Roberto, Curigliano Giuseppe, Rotmensz Nicole, Robertson Chris, Colleoni Marco, Zurrida Stefano, Nolè Franco, de Braud Filippo, Orlando Laura, Leonardi Maria Cristina, Galimberti Viviana, Intra Mattia, Veronesi Paolo, Renne Giuseppe, Cinieri Saverio, Audisio Riccardo A, Luini Alberto, Orecchia Roberto, Viale Giuseppe, Goldhirsch Aron
Department of Surgery, European Institute of Oncology, Milan, Italy.
Cancer. 2004 Sep 15;101(6):1302-10. doi: 10.1002/cncr.20535.
Aging remains one of the single greatest risk factors for the development of new breast carcinoma. The aim of the study was to evaluate the relation between biologic features at first diagnosis of breast carcinoma and treatment choice for postmenopausal women > or = 50 years to optimize treatment in the elderly.
The sample included 2999 consecutive postmenopausal patients referred for surgery at the European Institute of Oncology (Milan, Italy) from April 1997 to February 2002. The patients were grouped according to age: young postmenopausal (YPM; 50-64 years, n = 2052), older postmenopausal (OPM; 65-74, n = 801), and elderly postmenopausal (EPM; > or = 75, n = 146).
EPM patients referred to surgery had larger tumors compared with YPM patients (pT4: 6.7% vs. 2.4%) as well as greater lymph node involvement (lymph node positive: 62.5% vs. 51.3%). EPM patients showed a higher degree of estrogen and progesterone receptor expression (P < 0.01), less peritumoral vascular invasion (P < 0.01), and less HER-2/neu expression (P < 0.01) than YPM patients. Comorbidities were more often recorded for elderly patients (72% EPM vs. 45% YPM; P < 0.001), did not influence surgical choices, and were similar across groups (breast conservation: 73.9%, 76.9%, and 72.9%, respectively). No systemic therapy (either chemotherapy or endocrine therapy) was recommended for 19.1% of the EPM compared with 5.4% and 4.7% of the two other groups.
In spite of larger tumor size at presentation, older patients had tumors with more favorable biologic characteristics, when compared with younger postmenopausal patients. Reluctance to prescribe systemic treatments was due to the complexity of evaluation for these patients. Taking into account the data from the current study and given the climate of uncertainty regarding optimal treatment, the authors decided to individualize care on the basis of biologic characteristics, comorbidity, social support, functional status, and patient preferences. Trials of tailored adjuvant therapy should be a health care priority.
衰老仍然是新发乳腺癌的最大单一风险因素之一。本研究的目的是评估绝经后年龄≥50岁女性首次诊断乳腺癌时的生物学特征与治疗选择之间的关系，以优化老年患者的治疗。
样本包括1997年4月至2002年2月在欧洲肿瘤研究所（意大利米兰）连续接受手术治疗的2999例绝经后患者。患者按年龄分组：年轻绝经后组（YPM；50 - 64岁，n = 2052）、老年绝经后组（OPM；65 - 74岁，n = 801）和高龄绝经后组（EPM；≥75岁，n = 146）。
与YPM患者相比，接受手术治疗的EPM患者肿瘤更大（pT4：6.7%对2.4%），淋巴结受累情况也更严重（淋巴结阳性：62.5%对51.3%）。与YPM患者相比，EPM患者雌激素和孕激素受体表达程度更高（P < 0.01），肿瘤周围血管侵犯更少（P < 0.01），HER - 2/neu表达也更少（P < 0.01）。老年患者合并症记录更常见（EPM组72%对YPM组45%；P < 0.001），但不影响手术选择，且各年龄组相似（保乳手术：分别为73.9%、76.9%和72.9%）。19.1%的EPM患者未被推荐进行全身治疗（化疗或内分泌治疗），而其他两组分别为5.4%和4.7%。
尽管初诊时肿瘤较大，但与年轻绝经后患者相比，老年患者的肿瘤生物学特征更有利。不愿给予全身治疗是因为对这些患者评估复杂。考虑到本研究的数据以及关于最佳治疗存在不确定性的情况，作者决定根据生物学特征、合并症、社会支持、功能状态和患者偏好进行个体化治疗。量身定制辅助治疗的试验应成为医疗保健的优先事项。
