School of Pharmacy, University of Maryland Baltimore, Maryland, USA.
J Am Geriatr Soc. 2011 Apr;59(4):637-46. doi: 10.1111/j.1532-5415.2011.03351.x. Epub 2011 Mar 31.
To investigate the survival benefit associated with chemotherapy receipt in older women with estrogen receptor-negative (ER-) Stage IV breast cancer.
Observational, retrospective cohort study using Cox proportional hazards regression to determine effect of chemotherapy on hazard of all-cause mortality. The two samples were an overall sample (n=1,519) and a propensity score-matched sample (n=580) to control for selection to treatment receipt. Hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained for regression models.
U.S. women within the National Cancer Institute Surveillance, Epidemiology and End Results cancer registries (SEER) linked to Medicare enrollment and claims database.
Female Medicare beneficiaries aged 66 and older with Stage IV ER- breast cancer diagnosed between 1999 and 2005.
Outcome measure was all-cause death during the follow-up period. Survival was measured as time from breast cancer diagnosis until death or last follow-up date. Information on receipt of chemotherapy, defined as chemotherapy received within 6 months after diagnosis, was obtained from linked Medicare claims.
One thousand five hundred nineteen ER- women diagnosed with metastatic breast cancer were identified; 494 (33%) received chemotherapy. Chemotherapy was associated with a statistically significant survival benefit (HR=0.61, 95% CI=0.54-0.70). Age did not modify the survival benefit of chemotherapy.
Chemotherapy received within 6 months after diagnosis was associated with a 39% lower hazard of death within the time period for the study. These findings reflect chemotherapy use outside of the clinical trial setting and have important clinical and policy implications for the study of treatments in older women with advanced ER- breast cancer.
调查化疗对雌激素受体阴性（ER-）IV 期乳腺癌老年女性生存获益的影响。
采用 Cox 比例风险回归观察性回顾性队列研究，以确定化疗对全因死亡率风险的影响。两个样本为总体样本（n=1519）和倾向评分匹配样本（n=580），以控制治疗接受的选择。回归模型获得了风险比（HR）和 95%置信区间（CI）。
美国国家癌症研究所监测、流行病学和最终结果癌症登记处（SEER）内的女性，这些女性与医疗保险登记和索赔数据库相关联。
年龄在 66 岁及以上、诊断为 1999 年至 2005 年间患有 IV 期 ER-乳腺癌的女性医疗保险受益人的女性。
结果是随访期间的全因死亡。生存时间从乳腺癌诊断到死亡或最后一次随访日期进行测量。化疗的接受情况（定义为诊断后 6 个月内接受的化疗）的信息来自相关的医疗保险索赔。
确定了 1519 名患有转移性乳腺癌的 ER-女性，其中 494 名（33%）接受了化疗。化疗与统计学上显著的生存获益相关（HR=0.61，95%CI=0.54-0.70）。年龄并没有改变化疗的生存获益。
诊断后 6 个月内接受的化疗与研究期间死亡风险降低 39%相关。这些发现反映了临床试验之外的化疗使用，对研究老年女性晚期 ER-乳腺癌的治疗具有重要的临床和政策意义。
