年龄和合并症对 HER2 阳性早期乳腺癌患者治疗决策的影响。
The influences of age and co-morbidities on treatment decisions for patients with HER2-positive early breast cancer.
机构信息
Sussex Cancer Centre, Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex BN2 5BE, United Kingdom.
出版信息
Crit Rev Oncol Hematol. 2010 Nov;76(2):127-32. doi: 10.1016/j.critrevonc.2010.01.002. Epub 2010 Jan 22.
OBJECTIVE
To investigate the influences of age and co-morbidities on the use of adjuvant chemotherapy and trastuzumab in patients with HER2-positive early breast cancer.
METHODS
Thirty surgeons and 101 oncologists reviewed the profiles of 16 hypothetical patients which included details of age, tumour size/grade, nodal/ER status, and co-morbidities. Respondents viewed different patient profiles. Oncologists were asked how likely they would be to prescribe chemotherapy ± trastuzumab. Surgeons were asked whether they would refer to an oncologist.
RESULTS
Oncologists' treatment decisions were most affected by age and co-morbidities: 81% would prescribe chemotherapy for a high-risk patient aged 68 years, but only 47% for an otherwise identical patient aged 73 years. The majority of surgeons (84%) would still refer older patients.
CONCLUSIONS
National variation in the use of adjuvant chemotherapy in women aged ≥70 years with high-risk breast cancer is substantial. Practice audits or clinical trials addressing the outcomes of systemic adjuvant therapy are needed for this ever-increasing population of patients.
目的
研究年龄和合并症对人表皮生长因子受体 2（HER2）阳性早期乳腺癌患者辅助化疗和曲妥珠单抗使用的影响。
方法
30 名外科医生和 101 名肿瘤学家查看了 16 名假设患者的个人资料，其中包括年龄、肿瘤大小/分级、淋巴结/雌激素受体状态和合并症的详细信息。受访者查看了不同的患者资料。肿瘤学家被问及他们开具化疗±曲妥珠单抗的可能性有多大。外科医生被问及他们是否会转介给肿瘤学家。
结果
肿瘤学家的治疗决策受年龄和合并症的影响最大：81%的医生会为年龄 68 岁的高危患者开具化疗，但对于年龄 73 岁、其他方面相同的患者，只有 47%的医生会开具化疗。大多数外科医生（84%）仍会转介老年患者。
结论
在年龄≥70 岁且患有高危乳腺癌的女性中，辅助化疗的使用存在明显的国家差异。需要针对这一不断增加的患者群体进行系统辅助治疗结果的实践审查或临床试验。
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