Section of Geriatrics, Boston University Medical Center, 88 East Newton Street, Robinson Building, Boston, MA 02118, USA.
Eur J Cancer. 2012 Apr;48(6):805-12. doi: 10.1016/j.ejca.2011.06.016. Epub 2011 Jul 7.
To examine five- and ten-year survival based on cancer-specific geriatric assessment (C-SGA) in older women with early stage breast cancer.
We evaluated 660 women ≥65-years old diagnosed with stage I-IIIA primary breast cancer and attending physician permission to contact in four geographic regions in the United States of America (USA). Data were collected over ten-years of follow-up from consenting women's medical records, telephone interviews, National Death Index and Social Security Death Index. C-SGA was described by four domains using six measures: socio-demographic (financial resources); clinical (comorbidity, obesity); function (physical function limitations); and psychosocial (general mental health, social support). Survival from all-cause and breast-cancer-specific mortality and receipt of guideline-recommended therapy was assessed for different groups of subjects with C-SGA domain deficits (cut-off ≥3 deficits).
The proportion of women with ≥3 C-SGA deficits surviving ten-years was consistently statistically significantly lower (all-cause 26% versus 46% and breast-cancer-specific 76% versus 89%, p≤0.04). The proportion significantly decreased as number of C-SGA deficits increased (linear trend p<0.0001). Receipt of guideline-recommended therapy decreased with age but not consistently by number of C-SGA deficits. The all-cause and breast-cancer-specific death rate at five- and ten-years was consistently approximately two times higher in women with ≥3 C-SGA deficits even when fully adjusted for confounding factors (HR(5-yrAllCauseFullyAdjusted)=1.87 [1.36-2.57], HR(10-yrAllCauseFullyAdjusted)=1.74 [1.35-2.15], HR(5-yrBreastCancerFullyAdjusted)=1.95 [1.18-3.20], HR(10-yrBreastCancerFullyAdjusted)=1.99 [1.21-3.28]).
Regardless of age and stage of disease, C-SGA predicts five- and ten-year all-cause and breast-cancer-specific survival in older women. Hence, C-SGA may provide an effective strategy to guide treatment decision-making and to identify risk factors for intervention.
基于癌症特定的老年综合评估（C-SGA），研究老年女性早期乳腺癌的五年和十年生存率。
我们评估了 660 名年龄≥65 岁、诊断为 I 期至 IIIA 期原发性乳腺癌且获得美国四个地理区域的主治医生同意联系的女性。数据来自 10 年的随访，来源于同意的女性的病历、电话访谈、国家死亡索引和社会安全死亡索引。C-SGA 由四个领域通过六个指标来描述：社会人口统计学（经济资源）；临床（合并症、肥胖）；功能（身体功能受限）；以及心理社会（一般心理健康、社会支持）。对具有 C-SGA 领域缺陷（缺陷数≥3，切点）的不同组患者进行全因和乳腺癌特异性死亡率以及接受指南推荐治疗的评估。
C-SGA 缺陷数≥3 的女性在十年时的存活率始终具有统计学显著差异（全因 26% vs. 46%和乳腺癌特异性 76% vs. 89%，p≤0.04）。随着 C-SGA 缺陷数的增加，比例显著下降（线性趋势 p<0.0001）。接受指南推荐的治疗与年龄相关，但与 C-SGA 缺陷数不一致。即使在充分调整混杂因素后，C-SGA 缺陷数≥3 的女性的全因和乳腺癌特异性五年和十年死亡率始终约为两倍（5 年全因调整后 HR（5-yrAllCauseFullyAdjusted）=1.87[1.36-2.57]，10 年全因调整后 HR（10-yrAllCauseFullyAdjusted）=1.74[1.35-2.15]，5 年乳腺癌特异性调整后 HR（5-yrBreastCancerFullyAdjusted）=1.95[1.18-3.20]，10 年乳腺癌特异性调整后 HR（10-yrBreastCancerFullyAdjusted）=1.99[1.21-3.28]）。
无论年龄和疾病阶段如何，C-SGA 均可预测老年女性的五年和十年全因和乳腺癌特异性生存率。因此，C-SGA 可能提供一种有效的策略来指导治疗决策，并确定干预的风险因素。
