辅助在线计划在老年乳腺癌患者中的有效性：一项基于人群的研究。

Validity of Adjuvant! Online program in older patients with breast cancer: a population-based study.

机构信息

Department of Surgery, Leiden University Medical Centre, Leiden, Netherlands; Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Netherlands.

Department of Medical Decision Making, Leiden University Medical Centre, Leiden, Netherlands.

出版信息

Lancet Oncol. 2014 Jun;15(7):722-9. doi: 10.1016/S1470-2045(14)70200-1. Epub 2014 May 13.

DOI:10.1016/S1470-2045(14)70200-1

PMID:24836274

Abstract

BACKGROUND

Adjuvant! Online is a prediction tool that can be used to aid clinical decision making in patients with breast cancer. It was developed in a patient population aged 69 years or younger, and subsequent validation studies included small numbers of older patients. Since older patients with breast cancer differ from younger patients in many aspects, the aim of this study was to investigate the validity of Adjuvant! Online in a large cohort of unselected older patients.

METHODS

We included patients from the population-based FOCUS cohort, which included all consecutive patients aged 65 years or older who were diagnosed with invasive or in-situ breast cancer between Jan 1, 1997, and Dec 31, 2004, in the southwestern part of the Netherlands. We included all patients who fulfilled the criteria as stated by Adjuvant! Online: patients with unilateral, unicentric, invasive adenocarcinoma; no evidence of metastatic or residual disease; no evidence of T4 features; and no evidence of inflammatory breast cancer. We entered data from all patients with the "average for age" comorbidity status (model 1) and with an individualised comorbidity status (model 2).

FINDINGS

We included 2012 patients. Median age of patients in the cohort was 74·0 years (IQR 69·0-79·0). 904 (45%) of 2012 patients died during follow-up, whereas 326 (16%) patients had recurrence. Median follow-up for overall survival was 9·0 years (IQR 7·4-10·7), and 6·6 years (4·4-6·6) for patients without recurrence. Using model 1, Adjuvant! Online overestimated 10-year overall survival by 9·8% ([95% CI 5·9-13·7], p<0·0001) and 10-year cumulative recurrence survival by 8·7% ([6·7-10·7], p<0·0001). By contrast, when using model 2, Adjuvant! Online underestimated the 10-year overall survival by -17·1% ([95% CI -21·0 to -13·2], p<0·0001). However, when using model 2, Adjuvant! Online predicted cumulative recurrence accurately in all patients (-0·7% [95% CI -2·7-1·3], p=0·48).

INTERPRETATION

Adjuvant! Online does not accurately predict overall survival and recurrence in older patients with early breast cancer.

FUNDING

Dutch Cancer Foundation.

摘要

背景

Adjuvant! Online 是一种预测工具，可用于辅助乳腺癌患者的临床决策。它是在年龄为 69 岁或以下的患者人群中开发的，随后的验证研究纳入了少量年龄较大的患者。由于年龄较大的乳腺癌患者在许多方面与年轻患者不同，因此本研究旨在调查 Adjuvant! Online 在未经选择的大量老年患者中的有效性。

方法

我们纳入了来自基于人群的 FOCUS 队列的患者，该队列包括 1997 年 1 月 1 日至 2004 年 12 月 31 日期间在荷兰西南部诊断为单侧、单中心、浸润性腺癌的 65 岁或以上的所有连续患者，原位乳腺癌；无转移或残留疾病的证据；无 T4 特征的证据；无炎性乳腺癌的证据。我们将所有符合 Adjuvant! Online 标准的患者的数据纳入：年龄平均合并症状态（模型 1）和个体化合并症状态（模型 2）。

结果

我们纳入了 2012 名患者。队列中患者的中位年龄为 74.0 岁（IQR 69.0-79.0）。904 名（45%）2012 名患者在随访期间死亡，326 名（16%）患者出现复发。总生存的中位随访时间为 9.0 年（IQR 7.4-10.7），无复发患者的中位随访时间为 6.6 年（4.4-6.6）。使用模型 1，Adjuvant! Online 高估了 10 年总生存率 9.8%（[95%CI 5.9-13.7]，p<0.0001）和 10 年累积复发生存率 8.7%（[6.7-10.7]，p<0.0001）。相比之下，当使用模型 2 时，Adjuvant! Online 低估了 10 年总生存率 -17.1%（[95%CI -21.0 至 -13.2]，p<0.0001）。然而，当使用模型 2 时，Adjuvant! Online 准确预测了所有患者的累积复发率（-0.7%[95%CI -2.7-1.3]，p=0.48）。