Livi Lorenzo, Paiar Fabiola, Saieva Calogero, Simontacchi Gabriele, Nori Jacopo, Sanchez Luis, Santini Roberto, Mangoni Monica, Fondelli Simona, Distante Vito, Bianchi Simonetta, Biti Gianpaolo
Radiotherapy Unit, University o Florence, Florence, Italy.
Breast J. 2006 Jul-Aug;12(4):353-9. doi: 10.1111/j.1075-122X.2006.00275.x.
There is a significant difference in the extent of treatment offered to the elderly with breast cancer; in the United States, while 98% of patients less than 65 years of age receive standard treatment, 81% of those older than 65 years were treated according to protocol. This study's goal was to evaluate disease-specific survival and local-regional recurrence in breast cancer patients more than 65 years of age at diagnosis. A total of 1500 patients with invasive breast carcinoma were treated consecutively from May 1971 to July 2002 at the University of Florence, Florence, Italy. All patients were more than 65 years of age. The median age was 70.6 years (range 65.1-87.3 years). The median follow-up was 8.7 years (range 1-30 years). The crude probability of survival (or relapse occurrence) was estimated using the Kaplan-Meier method and survival (or relapse occurrence) comparisons were carried out using Cox proportional hazard regression models. The Cox regression model by stepwise selection showed as independent prognostic factors for disease-specific survival (DSS), the occurrence of a local relapse (p < 0.0001), pN status (p < 0.0001), the type of surgery (p < 0.0001), and the use of radiotherapy (p < 0.0006) and chemotherapy (p = 0.01). For local disease-free survival (LDFS), the Cox regression model by stepwise selection showed that mastectomy (p < 0.0001), histotype (p < 0.0001), pN status (p < 0.0001), and pT status (p = 0.001) were the only independent prognostic factors. Age was not a prognostic factor for DSS nor LDFS. We suggest treating patients with appropriate treatment for their prognostic factors.
在为老年乳腺癌患者提供的治疗程度上存在显著差异；在美国，65岁以下的患者中有98%接受了标准治疗，而65岁以上的患者中只有81%按照方案接受了治疗。本研究的目的是评估诊断时年龄超过65岁的乳腺癌患者的疾病特异性生存率和局部区域复发情况。1971年5月至2002年7月期间，意大利佛罗伦萨大学对1500例浸润性乳腺癌患者进行了连续治疗。所有患者年龄均超过65岁。中位年龄为70.6岁（范围65.1 - 87.3岁）。中位随访时间为8.7年（范围1 - 30年）。采用Kaplan - Meier方法估计生存（或复发发生）的粗概率，并使用Cox比例风险回归模型进行生存（或复发发生）比较。通过逐步选择的Cox回归模型显示，局部复发的发生（p < 0.0001）、pN状态（p < 0.0001）、手术类型（p < 0.0001）、放疗的使用（p < 0.0006）和化疗的使用（p = 0.01）是疾病特异性生存（DSS）的独立预后因素。对于局部无病生存（LDFS），通过逐步选择的Cox回归模型显示，乳房切除术（p < 0.0001）、组织学类型（p < 0.0001）、pN状态（p < 0.0001）和pT状态（p = 0.001）是仅有的独立预后因素。年龄不是DSS和LDFS的预后因素。我们建议根据患者的预后因素给予适当的治疗。
