Department of Surgery, Institut Curie, Paris, France.
Ann Surg Oncol. 2010 Jun;17(6):1530-8. doi: 10.1245/s10434-010-0967-6. Epub 2010 Feb 23.
The treatment of choice for elderly women with breast cancer remains controversial. This retrospective analysis of a cohort from a single institution was designed to evaluate whether such patients are really undertreated because of their age and to reappraise their usual management.
The characteristics of 538 patients aged > or = 70 years with operable breast cancer, treated between 1995 and 1999, were retrospectively analyzed comparing patients aged 70 to 75 years (group I, n = 288), 75 to 80 years (group II, n = 156), and > or = 80 years (group III, n = 94). Cause-specific survival, distant recurrence-free interval, and local control were estimated by the Kaplan-Meier method and compared by log rank test. Multivariate analysis used Cox regression.
In group III, tumors were more frequently T2 than T1 (P < 0.0001) and estrogen receptor negative (P = 0.045) than in groups I and II. Surgery was performed in 94.6% of patients, breast-conserving in 72.1% (62% in group III; P = 0.0015) with axillary dissection in 89.2% (77% in group III; P = 0.0015); 100% received radiotherapy after lumpectomy (hypofractionated in 63% of group III; P < 0.0001). Adjuvant hormone therapy and chemotherapy were administered to 57 and 3.7% of patients, respectively. At 7 years, no difference in the three groups was observed for cause-specific survival (91% for group I, 89% for group II, 86% for group III) distant recurrence-free interval, and local control (>90%).
Elderly patients with operable breast cancer who are completely and correctly treated with realistic treatment options that are based on surgery and adjuvant radiotherapy have a similar chance of being cured as younger patients.
对于老年乳腺癌患者，目前仍存在治疗选择的争议。本研究通过对单中心回顾性队列分析，旨在评估老年患者是否因年龄因素导致治疗不足，并重新评估其常规治疗策略。
分析了 1995 年至 1999 年间 538 例 70 岁及以上可手术乳腺癌患者的临床特征，比较了 70 至 75 岁（I 组，288 例）、75 至 80 岁（II 组，156 例）和 80 岁及以上（III 组，94 例）患者的特点。采用 Kaplan-Meier 法计算无病生存、远处无复发生存和局部控制率，采用 log-rank 检验比较组间差异。多因素分析采用 Cox 回归模型。
与 I 组和 II 组相比，III 组肿瘤更常为 T2 期（P<0.0001），雌激素受体阴性（P=0.045）。94.6%的患者接受了手术治疗，72.1%（62%在 III 组）接受了保乳手术（P=0.0015），89.2%（77%在 III 组）接受了腋窝清扫术（P=0.0015）；100%的患者在保乳术后接受了放疗（63%在 III 组中接受了调强放疗，P<0.0001）。分别有 57%和 3.7%的患者接受了辅助激素治疗和化疗。7 年时，I 组、II 组和 III 组患者的无病生存率（91%、89%和 86%）、远处无复发生存率和局部控制率（>90%）均无差异。
对于接受手术和辅助放疗等综合治疗的可手术乳腺癌老年患者，如能合理选择治疗方案并正确治疗，其治愈机会与年轻患者相似。
