Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, Texas.
Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, Texas.
J Am Geriatr Soc. 2015 Aug;63(8):1570-82. doi: 10.1111/jgs.13523. Epub 2015 Jul 22.
To compare the effectiveness of chemotherapy in prolonging survival according to age in breast and colon cancer.
Retrospective cohort study with a matched cohort analysis based on the conditional probability of receiving chemotherapy.
The 16 Surveillance, Epidemiology, and End Results (SEER) areas from the SEER-Medicare linked database.
Women diagnosed with Stage I to IIIa hormone receptor-negative breast cancer (n = 14,440) and 26,893 men and women with Stage III colon cancer (n = 26,893) aged 65 and older in 1992 to 2009.
The main exposure was the receipt of chemotherapy, and the main outcome was mortality.
In women with breast cancer aged 65 to 69, the risk of all-cause mortality was statistically significantly lower in those who received chemotherapy than in those who did not in the entire cohort (hazard ratio (HR) = 0.70, 95% confidence interval (CI) = 0.57-0.88) and in a propensity-matched cohort (HR = 0.82, 95% CI = 0.70-0.96) after adjusting for measured confounders. These patterns were similar in participants aged 70 to 74 and 75 to 79, but in women aged 80 to 84 and 85 to 89, risk of all-cause mortality was no longer significantly lower in those receiving chemotherapy in the entire and matched cohorts, except that, in a small number of women who received doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan), risk of mortality was significantly lower for those aged 80 to 84. Chemotherapy appeared to be effective in all ages from 65 through 84 in participants with Stage III colon cancer. For example, in those aged 85 to 89, chemotherapy was significantly associated with lower risk of mortality in the entire cohort (HR = 0.79, 95% CI = 0.67-0.92) and the matched cohort (HR = 0.79, 95% CI = 0.66-0.95).
The effectiveness of chemotherapy decreased with age in participants with breast cancer, in whom chemotherapy appears to be effective until age 79 except for the doxorubicin-cyclophosphamide combination, which was effective in participants aged 80 to 84. In individuals with Stage III colon cancer, chemotherapy appears to be effective to age 89. These findings were consistent with those of randomized clinical trials.
比较化疗在延长乳腺癌和结肠癌患者生存时间方面的效果，按年龄进行分层。
基于接受化疗的条件概率，对 1992 年至 2009 年期间来自监测、流行病学和最终结果（SEER）-医疗保险数据库的 16 个监测区的回顾性队列研究和匹配队列分析。
SEER 地区。
年龄在 65 岁及以上的 14440 例激素受体阴性Ⅰ期至Ⅲa 期乳腺癌女性患者和 26893 例男性和女性Ⅲ期结肠癌患者。
接受化疗。
死亡率。
在 65 至 69 岁的乳腺癌女性中，与未接受化疗者相比，接受化疗者的全因死亡率风险显著降低（整个队列的危险比[HR] = 0.70，95%置信区间[CI] = 0.57-0.88；匹配队列的 HR = 0.82，95% CI = 0.70-0.96），且在调整了测量性混杂因素后仍保持一致。在 70 至 74 岁和 75 至 79 岁的患者中，也观察到了类似的模式，但在 80 至 84 岁和 85 岁及以上的患者中，整个和匹配队列中接受化疗者的全因死亡率风险不再显著降低，只有接受多柔比星（阿霉素）联合环磷酰胺（环磷酰胺）化疗的患者例外，80 至 84 岁组患者的死亡率风险显著降低。对于 85 岁及以上的患者，化疗与整个队列（HR = 0.79，95% CI = 0.67-0.92）和匹配队列（HR = 0.79，95% CI = 0.66-0.95）的较低死亡率风险显著相关。在 Ⅲ期结肠癌患者中，化疗似乎一直有效到 89 岁。
在乳腺癌患者中，化疗的有效性随年龄增长而降低，除多柔比星联合环磷酰胺方案外，在 79 岁之前化疗可能有效，该方案在 80 至 84 岁的患者中有效。在 Ⅲ期结肠癌患者中，化疗似乎一直有效到 89 岁。这些发现与随机临床试验的结果一致。
