Pôle d'Hématologie et d'Oncologie, Hôpitaux Universitaires de Strasbourg, France.
Crit Rev Oncol Hematol. 2011 Aug;79(2):196-204. doi: 10.1016/j.critrevonc.2010.06.005. Epub 2010 Jul 23.
Elderly breast cancer (EBC) patients are often denied adjuvant chemotherapy because of age. Breast cancer is among the most frequent cancer in Western Countries and recent data suggest that adjuvant chemotherapy could be active in selected elderly patients. We investigated the impact of age and comprehensive geriatric assessment (CGA) among other variables taken into account in tumor boards to recommend adjuvant chemotherapy in EBC patients.
METHOD(S): We retrospectively reviewed breast cancer tumor board records of all consecutive EBC patients (over 70 years old) discussed from July 2006 to July 2009 in our institution. The recorded variables included age, comorbidities, tumor stage, grade, ER/PR and HER2 status, treatment characteristics and CGA conclusions. Agreement with breast cancer treatment guidelines was verified. Reasons for deviations were recorded.
RESULT(S): A total of 192 early EBC patients files (mean age 76.7 years, range 70-98) were analyzed. Elderly patients were less likely to receive adjuvant chemotherapy even when deemed appropriate by guidelines (p<.001). Out of 118 patients with ≥1 risk factors (pT2-4, N+, RH-, SBR III), 70 were proposed adjuvant chemotherapy. In multivariate analysis, age >80 years, but not CGA result, was an independent variable associated with a decreased likelihood to receiving adjuvant chemotherapy. Moreover, 93 patients (48.4%) underwent CGA, of whom no Balducci's class III patient received adjuvant chemotherapy. An appropriate treatment was administered in only 69% and 42% of Balducci's class I and II patients, respectively.
CONCLUSION(S): Our results suggest that age remains an independent variable associated with a decreased use of adjuvant chemotherapy. However, in our series systemic adjuvant chemotherapy was probably underused in "fit" patients. Further efforts are needed to better integrate CGA into tumor boards proposals for early EBC patients.
由于年龄原因，老年乳腺癌（EBC）患者常被拒绝接受辅助化疗。乳腺癌是西方国家最常见的癌症之一，最近的数据表明，辅助化疗可能对某些老年患者有效。我们研究了年龄以及肿瘤委员会考虑的其他变量（包括综合老年评估（CGA））对推荐 EBC 患者接受辅助化疗的影响。
我们回顾性分析了 2006 年 7 月至 2009 年 7 月在我院讨论的所有连续 EBC 患者（年龄>70 岁）的乳腺癌肿瘤委员会记录。记录的变量包括年龄、合并症、肿瘤分期、分级、ER/PR 和 HER2 状态、治疗特征和 CGA 结论。验证了与乳腺癌治疗指南的一致性。记录了偏差的原因。
共分析了 192 例早期 EBC 患者的病历（平均年龄 76.7 岁，范围 70-98 岁）。即使符合指南建议（p<.001），老年患者接受辅助化疗的可能性也较低。在 118 例具有≥1 个危险因素（pT2-4、N+、RH-、SBR III）的患者中，70 例被建议接受辅助化疗。多变量分析显示，年龄>80 岁，但不是 CGA 结果，是与接受辅助化疗可能性降低相关的独立变量。此外，93 例（48.4%）患者进行了 CGA，其中无 Balducci 类 III 患者接受辅助化疗。仅 69%和 42%的 Balducci 类 I 和 II 患者接受了适当的治疗。
我们的结果表明，年龄仍然是与辅助化疗使用率降低相关的独立变量。然而，在我们的系列中，系统辅助化疗在“适合”的患者中可能使用不足。需要进一步努力，将 CGA 更好地纳入肿瘤委员会对早期 EBC 患者的建议。
