治疗不足对老年女性年龄相关乳腺癌特异性生存差异的影响。

Effect of undertreatment on the disparity in age-related breast cancer-specific survival among older women.

作者信息

Owusu Cynthia, Lash Timothy L, Silliman Rebecca A

机构信息

Hematology and Medical Oncology Section, Department of Medicine, Boston University School of Medicine, Evans Biomedical Research Center, Boston, MA 02118-2393, USA.

出版信息

Breast Cancer Res Treat. 2007 Apr;102(2):227-36. doi: 10.1007/s10549-006-9321-x. Epub 2006 Sep 27.

DOI:10.1007/s10549-006-9321-x

PMID:17004115

Abstract

OBJECTIVES

Assess the relationship between age and breast cancer-specific survival among older women and determine whether the observed age-related disparities in survival is explained by differences in breast cancer treatments received.

METHODS

Women > or =65 years old at diagnosis with stage I-IIIA breast cancer diagnosed between 1997 and 1998 were recruited from four regions of the United States and followed prospectively for 5 years after diagnosis. Data was obtained from tumor registries, medical records, and telephone interviews. The primary endpoint was breast cancer-specific survival. Our independent variables were age operationalized as < or =75 years vs. >75 years, and receipt of recommended guideline therapy, adapted from the National Institutes of Health guideline consensus conference.

RESULTS

Of 689 women, 36% were >75 years. Women >75 years were less likely to have received the following; axillary lymph node dissection (84% vs. 93%, P = 0.0003), radiotherapy (40% vs. 54%, P = 0.0003), definitive primary therapy (71% vs. 84%, P < 0.0001), chemotherapy (9% vs. 28%, P < 0.0001), and guideline therapy (31% vs. 54%, P < 0.0001). The 5-year breast cancer-specific survival was 95% (95% confidence interval [CI], 90%, 97%) for those < or =75 years who received guideline therapy, 94% (95% CI, 90%, 97%) for those < or =75 years who did not receive guideline therapy, 96% (95% CI, 88%, 99%) for those >75 years who received guideline therapy and 83% (95% CI, 74%, 89%) for those >75 years who did not receive guideline therapy, (P = 0.002) by the log-rank test.

CONCLUSION

Receipt of guideline therapy may reduce the age-related disparity in breast cancer survival among older women.

摘要

目的

评估老年女性年龄与乳腺癌特异性生存之间的关系，并确定观察到的生存方面与年龄相关的差异是否可由所接受的乳腺癌治疗差异来解释。

方法

从美国四个地区招募了1997年至1998年间确诊为I-IIIA期乳腺癌且诊断时年龄≥65岁的女性，并在诊断后进行了5年的前瞻性随访。数据来自肿瘤登记处、医疗记录和电话访谈。主要终点是乳腺癌特异性生存。我们的自变量为年龄，分为≤75岁与＞75岁，以及是否接受了根据美国国立卫生研究院指南共识会议改编的推荐指南治疗。

结果

在689名女性中，36%的女性年龄＞75岁。年龄＞75岁的女性接受以下治疗的可能性较小：腋窝淋巴结清扫术（84%对93%，P = 0.0003）、放疗（40%对54%，P = 0.0003）、确定性原发治疗（71%对84%，P < 0.0001）、化疗（9%对28%，P < 0.0001）以及指南治疗（31%对54%，P < 0.0001）。接受指南治疗的≤75岁女性的5年乳腺癌特异性生存率为95%（95%置信区间[CI]，90%，97%），未接受指南治疗的≤75岁女性为94%（95%CI，90%，97%），接受指南治疗的＞75岁女性为96%（95%CI，88%，99%），未接受指南治疗的＞75岁女性为83%（95%CI，74%，89%），对数秩检验显示（P = 0.002）。