Truong Pauline T, Lee Junella, Kader Hosam A, Speers Caroline H, Olivotto Ivo A
Radiation Therapy Program, Vancouver Island Centre, British Columbia Cancer Agency and the University of British Columbia, 2410 Lee Avenue, Victoria, BC, Canada V8R 6V5.
Eur J Cancer. 2005 Jun;41(9):1267-77. doi: 10.1016/j.ejca.2005.02.027.
This study examined tumour and treatment characteristics in elderly women treated with mastectomy without radiotherapy and compared their outcomes to younger counterparts. Data were analysed for 2362 women aged 50 years and older referred to the British Columbia Cancer Agency, Canada between 1989 and 1997. The women had invasive T1-4, N0-N3, M0 breast cancer treated with mastectomy without adjuvant radiotherapy. Clinical characteristics and patient outcomes were compared between two age cohorts: 50-69 (n = 1423) and 70+ years (n = 939). Median follow-up was 8.3 years. Tumours > 5 cm were present in 5% of women aged 50-69 and 3.5% of women aged 70+, respectively. The distribution of nodal stage was similar in the two age cohorts but older women were more likely to have fewer axillary nodes removed (P = 0.009). Fewer women aged 70+ had grade III histology (P = 0.002) and estrogen receptor (ER)-negative status (P < 0.001). The rates of systemic therapy use were comparable in the two age groups. With tumours > 5 cm, locoregional recurrence (LRR) were 13.7% and 30.0% in women aged 50-69 and 70+, respectively. With 1-3 positive nodes (N+), LRR were 14.8% and 13.0% in women aged 50-69 and 70+. In the presence of 4 N+, LRR were 16.8% and 30.8% in women aged 50-69 and 70+. On multivariate analysis, age was not significantly associated with LRR (P = 0.62). Independent prognostic factors for LRR were grade III histology, lymphovascular invasion and positive nodal status. This study suggests that despite more favourable tumour characteristics and comparable systemic therapy use, women aged 70+ years have similar or higher postmastectomy LRR risks compared to younger women. Chronologic age alone should not preclude these women from consideration of adjuvant radiotherapy.
本研究调查了接受乳房切除术且未接受放疗的老年女性的肿瘤及治疗特征，并将其结果与年轻女性进行比较。对1989年至1997年间转诊至加拿大不列颠哥伦比亚癌症机构的2362名50岁及以上女性的数据进行了分析。这些女性患有浸润性T1-4、N0-N3、M0乳腺癌，接受了乳房切除术且未接受辅助放疗。比较了两个年龄组的临床特征和患者结局：50-69岁组（n = 1423）和70岁及以上组（n = 939）。中位随访时间为8.3年。50-69岁女性中5%的肿瘤直径>5 cm，70岁及以上女性中这一比例为3.5%。两个年龄组的淋巴结分期分布相似，但老年女性切除的腋窝淋巴结较少的可能性更大（P = 0.009）。70岁及以上女性中组织学分级为III级（P = 0.002）和雌激素受体（ER）阴性状态（P < 0.001）的比例较低。两个年龄组的全身治疗使用率相当。肿瘤直径>5 cm时，50-69岁和70岁及以上女性的局部区域复发（LRR）率分别为13.7%和30.0%。有1-3个阳性淋巴结（N+）时，50-69岁和70岁及以上女性的LRR率分别为14.8%和13.0%。存在≥4个N+时，50-69岁和70岁及以上女性的LRR率分别为16.8%和30.8%。多因素分析显示年龄与LRR无显著相关性（P = 0.62）。LRR的独立预后因素为组织学分级III级、淋巴管浸润和阳性淋巴结状态。本研究表明，尽管老年女性的肿瘤特征更有利且全身治疗使用率相当，但与年轻女性相比，70岁及以上女性乳房切除术后的LRR风险相似或更高。仅年龄不应妨碍这些女性考虑辅助放疗。
