Siegelmann-Danieli Nava, Khandelwal Vivek, Wood G Craig, Mainali Roshan, Prichard Jeffrey, Murphy Timothy J, Evans James F, Yumen Omar, Bernath Albert M
Department of Hematology and Oncology, Geisinger Medical Center, Danville, PA, USA.
Clin Breast Cancer. 2006 Apr;7(1):59-66. doi: 10.3816/CBC.2006.n.014.
The current work assessed the independent contributions of age, comorbidities, tumor features, and treatment approach to the outcome of elderly patients with breast cancer.
Records of consecutive women aged > or = 70 years with a histologic diagnosis of first invasive breast cancer between 1971 and 2001 and available medical information were reviewed. Restaging to the 2002 TNM system and comorbidity data abstraction were performed. Primary outcomes were overall survival (OS) and breast cancer-specific survival (BCSS).
There were 992 patients with a median diagnosis age of 76 years, of whom 840 were approached with a curative intent. Significant comorbidities were recorded as none and > or = 3 in 13% and 44% of patients, respectively. The 5- and 10-year OS rates were 59% and 34%; corresponding BCSS rates were 74% and 62%, respectively. Of 693 patients who died during the study period, only 298 (43%) died from their tumors. Stage emerged as the strongest predictor determining OS and BCSS (P = 0.001). In curatively approached patients, age was the next dominant factor affecting survival length (P = 0.001). The comorbidities with significant effect on OS differed by stage and included heart failure, diabetes, and other common comorbidities in early tumors but only extremely debilitating ones in advanced-stage disease (P < 0.05). Significant favorable effect of systemic therapy emerged only in the univariate model.
This study confirms tumor stage as the strongest predictor of survival in elderly patients with breast cancer. It also indicates a significant role for age and comorbidities that varies by stage. Treatment effect should be interpreted with caution because of the retrospective study nature.
本研究评估年龄、合并症、肿瘤特征及治疗方法对老年乳腺癌患者预后的独立影响。
回顾1971年至2001年间年龄≥70岁、经组织学确诊为原发性浸润性乳腺癌且有可用医疗信息的连续女性患者记录。重新分期至2002年TNM系统并提取合并症数据。主要结局为总生存期（OS）和乳腺癌特异性生存期（BCSS）。
992例患者，中位诊断年龄76岁，其中840例接受了根治性治疗。分别有13%和44%的患者无明显合并症及合并症≥3种。5年和10年总生存率分别为59%和34%；相应的乳腺癌特异性生存率分别为74%和62%。在研究期间死亡的693例患者中，仅298例（43%）死于肿瘤。分期是决定总生存期和乳腺癌特异性生存期的最强预测因素（P = 0.001）。在接受根治性治疗的患者中，年龄是影响生存时间的下一个主要因素（P = 0.001）。对总生存期有显著影响的合并症因分期而异，早期肿瘤包括心力衰竭、糖尿病和其他常见合并症，而晚期疾病仅包括极度衰弱的合并症（P < 0.05）。全身治疗的显著有益效果仅在单因素模型中出现。
本研究证实肿瘤分期是老年乳腺癌患者生存的最强预测因素。它还表明年龄和合并症的作用因分期而异。由于本研究为回顾性研究性质，对治疗效果的解读应谨慎。
