Beth Israel Deaconess Medical Center, 1309 Beacon St, Office 202, Brookline, MA 02446, USA.
J Clin Oncol. 2011 Apr 20;29(12):1570-7. doi: 10.1200/JCO.2010.33.0472. Epub 2011 Mar 14.
To understand the impact of breast cancer on older women's survival, we compared survival of older women diagnosed with breast cancer with matched controls. METHODS Using the linked 1992 to 2003 Surveillance, Epidemiology, and End Results (SEER) -Medicare data set, we identified women age 67 years or older who were newly diagnosed with ductal carcinoma in situ (DCIS) or breast cancer. We identified women not diagnosed with breast cancer from the 5% random sample of Medicare beneficiaries residing in SEER areas.We matched patient cases to controls by birth year and registry (99% or 66,039 [corrected] patient cases matched successfully). We assigned the start of follow-up for controls as the patient cases' date of diagnosis. Mortality data were available through 2006. We compared survival of women with breast cancer by stage with survival of controls using multivariable proportional hazards models adjusting for age at diagnosis, comorbidity, prior mammography use, and sociodemographics. We repeated these analyses stratifying by age.
Median follow-up time was 7.7 years. Differences between patient cases and controls in sociodemographics and comorbidities were small (< 4%). Women diagnosed with DCIS (adjusted hazard ratio [aHR], 0.7; 95% CI, 0.7 to 0.7) or stage I disease (aHR, 0.8; 95% CI, 0.8 to 0.8) had slightly lower mortality than controls.Women diagnosed with stage II disease or higher had greater mortality than controls (stage II disease:aHR, 1.2; 95% CI, 1.2 to 1.2). The association of a breast cancer diagnosis with mortality declined with age among women with advanced disease [corrected].
Compared with matched controls, a diagnosis of DCIS or stage I breast cancer in older women is associated with better [corrected] survival, whereas a diagnosis of stage II or higher breast cancer is associated with worse survival.
为了了解乳腺癌对老年女性生存的影响，我们比较了确诊乳腺癌的老年女性与匹配对照者的生存情况。
我们利用 1992 年至 2003 年监测、流行病学和最终结果（SEER）-医疗保险数据集，确定了年龄在 67 岁及以上、新诊断为导管原位癌（DCIS）或乳腺癌的女性。我们从居住在 SEER 地区的医疗保险受益人的 5%随机样本中确定了未诊断患有乳腺癌的女性。我们通过出生年份和登记处将患者病例与对照者相匹配（99%或 66039[更正]患者病例成功匹配）。我们将对照者的随访开始时间设定为患者病例的诊断日期。通过 2006 年可获得死亡率数据。我们通过多变量比例风险模型比较了不同分期乳腺癌患者的生存情况与对照者的生存情况，该模型调整了诊断时的年龄、合并症、既往乳房 X 线摄影检查的使用情况以及社会人口统计学因素。我们还按年龄对这些分析进行了分层。
中位随访时间为 7.7 年。患者病例与对照者在社会人口统计学因素和合并症方面的差异较小（<4%）。与对照者相比，诊断为 DCIS（调整后的风险比[aHR]，0.7；95%可信区间，0.7 至 0.7）或 I 期疾病（aHR，0.8；95%可信区间，0.8 至 0.8）的女性死亡率略低。诊断为 II 期或更高期疾病的女性死亡率高于对照者（II 期疾病：aHR，1.2；95%可信区间，1.2 至 1.2）。在晚期疾病患者中，乳腺癌诊断与死亡率之间的关联随着年龄的增长而下降[更正]。
与匹配对照者相比，老年女性诊断为 DCIS 或 I 期乳腺癌与更好的[更正]生存相关，而诊断为 II 期或更高期乳腺癌与更差的生存相关。
