Smith Benjamin D, Haffty Bruce G, Hurria Arti, Galusha Deron H, Gross Cary P
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.
J Clin Oncol. 2006 Oct 20;24(30):4901-7. doi: 10.1200/JCO.2006.06.5938.
Clinical trials indicate that postmastectomy radiation therapy (PMRT) improves survival for women age younger than 70 years with high-risk breast cancer. However, for women age 70 years or older, the benefits of PMRT are unknown. As recent evidence suggests that certain adjuvant treatments appropriate for younger women may only be marginally beneficial for older women, we sought to determine whether PMRT improves survival for older women with breast cancer.
Using the Surveillance, Epidemiology and End Results Medicare data spanning 1992 to 1999, we identified 11,594 women age 70 years or older treated with mastectomy for invasive breast cancer. A proportional hazards model adjusted for clinical-pathologic covariates tested whether PMRT was associated with improved overall survival for low-risk (T1/2 N0), intermediate-risk (T1/2 N1), and high-risk (T3/4 and/or N2/3) patients.
A total of 502 (7%) of 7,416 low-risk, 242 (11%) of 2,145 intermediate-risk, and 785 (38%) of 2,053 high-risk patients received PMRT. Median follow-up was 6.2 years. For low- and intermediate-risk patients, PMRT was not associated with survival. For high-risk patients, PMRT was associated with a significant improvement in survival (hazard ratio, 0.85; 95% CI, 0.75 to 0.97; P = .02). Five-year adjusted survival was 50% for patients not treated with PMRT or chemotherapy, 56% for patients treated with PMRT only, 57% for patients treated with chemotherapy only, and 59% for patients treated with both PMRT and chemotherapy.
PMRT is associated with improved survival for older women with high-risk breast cancer. Randomized clinical trials are urgently needed to confirm this finding and define optimal treatment strategies for this patient group.
临床试验表明，对于年龄小于70岁的高危乳腺癌女性，乳房切除术后放射治疗（PMRT）可提高生存率。然而，对于70岁及以上的女性，PMRT的益处尚不清楚。由于最近的证据表明，某些适合年轻女性的辅助治疗对老年女性可能仅具有边际效益，我们试图确定PMRT是否能提高老年乳腺癌女性的生存率。
利用1992年至1999年的监测、流行病学和最终结果医疗保险数据，我们确定了11594名70岁及以上因浸润性乳腺癌接受乳房切除术的女性。采用针对临床病理协变量进行调整的比例风险模型，测试PMRT是否与低风险（T1/2 N0）、中度风险（T1/2 N1）和高风险（T3/4和/或N2/3）患者的总生存率提高相关。
7416名低风险患者中有502名（7%）、2145名中度风险患者中有242名（11%）、2053名高风险患者中有785名（38%）接受了PMRT。中位随访时间为6.2年。对于低风险和中度风险患者，PMRT与生存率无关。对于高风险患者，PMRT与生存率的显著提高相关（风险比，0.85；95%可信区间，0.75至0.97；P = 0.02）。未接受PMRT或化疗的患者5年调整生存率为50%，仅接受PMRT治疗的患者为56%，仅接受化疗的患者为57%，同时接受PMRT和化疗的患者为59%。
PMRT与老年高危乳腺癌女性的生存率提高相关。迫切需要进行随机临床试验来证实这一发现，并为该患者群体确定最佳治疗策略。
