Crivellari Diana, Aapro Matti, Leonard Robert, von Minckwitz Gunter, Brain Etienne, Goldhirsch Aron, Veronesi Andrea, Muss Hyman
Division of Medical Oncology C, Centro di Riferimento Oncologico National Cancer Institute, Aviano, PN Italy.
J Clin Oncol. 2007 May 10;25(14):1882-90. doi: 10.1200/JCO.2006.10.2079.
Screening and adjuvant postoperative therapies have increased survival among women with breast cancer. These tools are seldom applied in elderly patients, although the usually reported incidence of breast cancer is close to 50% in women 65 years or older, reaching 47% after 70 years in the updated Surveillance, Epidemiology, and End Results (SEER) database. Elderly breast cancer patients, even if in good medical health, were frequently excluded from adjuvant clinical trials. Women age 70 years who are fit actually have a median life expectancy of 15.5 years, ie, half of them will live much longer and will remain exposed for enough time to the potentially preventable risks of a relapse and specific death. In the last few years, a new concern about this issue has developed. Treatment now faces two major end points, as in younger women: to improve disease-free survival in the early stages, and to palliate symptoms in advanced disease. However, in both settings, the absolute benefit of treatment is critical because protecting quality of life and all its related aspects (especially functional status and independence), is crucial in older persons who have more limited life expectancy. Furthermore, the new hormonal compounds (aromatase inhibitors) and chemotherapeutic drugs (capecitabine, liposomal doxorubicin), are potentially less toxic than and equally as effective as older more established therapies. These new treatments bring new challenges including higher cost, and defining their benefit in elderly breast cancer must include an analysis of the cost/benefit ratio. These issues emphasize the urgent need to develop and support clinical trials for this older population of breast cancer patients both in the adjuvant and metastatic settings, a move that will take us from a prejudiced, age-based medicine to an evidence-based medicine.
筛查和术后辅助治疗提高了乳腺癌女性患者的生存率。尽管通常报告的乳腺癌发病率在65岁及以上女性中接近50%，在更新后的监测、流行病学和最终结果（SEER）数据库中70岁以后达到47%，但这些手段在老年患者中很少应用。老年乳腺癌患者，即使身体健康状况良好，也经常被排除在辅助临床试验之外。实际上，70岁身体状况良好的女性的预期寿命中位数为15.5年，也就是说，其中一半人会活得更长，并会在足够长的时间内面临复发和特定死亡等潜在可预防风险。在过去几年中，人们对这个问题产生了新的担忧。如今的治疗面临两个主要终点，与年轻女性一样：在早期提高无病生存率，在晚期缓解症状。然而，在这两种情况下，治疗的绝对益处至关重要，因为保护生活质量及其所有相关方面（尤其是功能状态和独立性），对预期寿命更有限的老年人至关重要。此外，新的激素化合物（芳香化酶抑制剂）和化疗药物（卡培他滨、脂质体阿霉素），其毒性可能比旧的成熟疗法更低且疗效相同。这些新疗法带来了新的挑战，包括成本更高，确定它们在老年乳腺癌中的益处必须包括对成本效益比的分析。这些问题强调了迫切需要在辅助和转移环境中为这一老年乳腺癌患者群体开展和支持临床试验，这一举措将使我们从基于偏见的年龄医学转向循证医学。
