老年早期乳腺癌患者：辅助放疗及癌症相关死亡的预测因素

Older Patients With Early-stage Breast Cancer: Adjuvant Radiation Therapy and Predictive Factors for Cancer-related Death.

作者信息

Nagar Himanshu, Yan Weisi, Christos Paul, Chao K S Clifford, Nori Dattatreyudu, Ravi Akkamma

机构信息

*Department of Radiation Oncology, New York Presbyterian-Hospital/Weill Cornell Medical College †Division of Biostatistics and Epidemiology, Department of Public Health, Weill Cornell Medical College, New York, NY.

出版信息

Am J Clin Oncol. 2017 Jun;40(3):300-305. doi: 10.1097/COC.0000000000000144.

DOI:10.1097/COC.0000000000000144

PMID:25333731

Abstract

PURPOSE

Studies have shown that older women are undertreated for breast cancer. Few data are available on cancer-related death in elderly women aged 70 years and older with pathologic stage T1a-b N0 breast cancer and the impact of prognostic factors on cancer-related death.

METHODS

The Surveillance, Epidemiology, and End Results (SEER) database was queried for women aged 70 years or above diagnosed with pT1a or pT1b, N0 breast cancer who underwent breast conservation surgery from 1999 to 2003. The Kaplan-Meier survival analysis was performed to evaluate breast cause-specific survival (CSS) and overall survival (OS), and the log-rank test was employed to compare CSS/OS between different groups of interest. Multivariable analysis (MVA), using Cox proportional hazards regression analysis, was performed to evaluate the independent effect of age, race, stage, grade, ER status, and radiation treatment on CSS. Adjusted hazard ratios were calculated from the MVA and reflect the increased risk of breast cancer death. Competing-risks survival regression was also performed to adjust the univariate and multivariable CSS hazard ratios for the competing event of death due to causes other than breast cancer.

RESULTS

Patients aged 85 and above had a greater risk of breast cancer death compared with patients aged 70 to 74 years (referent category) (adjusted hazard ratio [HRs]=1.98). Race had no effect on CSS. Patients with stage T1bN0 breast cancer had a greater risk of breast cancer death compared with stage T1aN0 patients (adjusted HR=1.35; P=0.09). ER negative patients had a greater risk of breast cancer death compared with ER positive patients (adjusted HR=1.59; P<0.017). Patients with higher grade tumors had a greater risk of breast cancer death compared with patients with grade 1 tumors (referent category) (adjusted HRs=1.69 and 2.96 for grade 2 and 3, respectively). Patients who underwent radiation therapy had a lower risk of breast cancer death compared with patients who did not (adjusted HR=0.55; P<0.0001).

CONCLUSIONS

Older patients with higher grade, pT1b, ER-negative breast cancer had increased risk of breast cancer-related death. Adjuvant radiation therapy may provide a CSS benefit in this elderly patient population.

摘要

目的

研究表明老年女性乳腺癌治疗不足。关于70岁及以上病理分期为T1a - b N0乳腺癌的老年女性癌症相关死亡情况以及预后因素对癌症相关死亡的影响，现有数据较少。

方法

查询监测、流行病学和最终结果（SEER）数据库，获取1999年至2003年期间诊断为pT1a或pT1b、N0乳腺癌且接受保乳手术的70岁及以上女性患者。采用Kaplan - Meier生存分析评估乳腺癌特异性生存（CSS）和总生存（OS），并使用对数秩检验比较不同感兴趣组之间的CSS/OS。采用Cox比例风险回归分析进行多变量分析（MVA），以评估年龄、种族、分期、分级、雌激素受体（ER）状态和放疗对CSS的独立影响。从MVA计算调整后的风险比，反映乳腺癌死亡风险增加情况。还进行了竞争风险生存回归分析，以针对除乳腺癌以外其他原因导致的死亡这一竞争事件调整单变量和多变量CSS风险比。

结果

85岁及以上患者与70至74岁患者（参照类别）相比，乳腺癌死亡风险更高（调整后风险比[HRs]=1.98）。种族对CSS无影响。T1bN0期乳腺癌患者与T1aN0期患者相比，乳腺癌死亡风险更高（调整后HR = 1.35；P = 0.09）。ER阴性患者与ER阳性患者相比，乳腺癌死亡风险更高（调整后HR = 1.59；P < 0.017）。肿瘤分级较高的患者与1级肿瘤患者（参照类别）相比，乳腺癌死亡风险更高（2级和3级调整后HRs分别为1.69和2.96）。接受放疗的患者与未接受放疗的患者相比，乳腺癌死亡风险更低（调整后HR = 0.55；P < 0.0001）。