Richards P, Ward S, Morgan J, Lagord C, Reed M, Collins K, Wyld L
Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK.
Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK.
Eur J Surg Oncol. 2016 Apr;42(4):489-96. doi: 10.1016/j.ejso.2015.12.012. Epub 2016 Jan 13.
To assess whether the proportion of patients aged 70 and over with ER+ operable breast cancer in England who are treated with surgery has changed since 2002, and to determine whether age and individual level factors including tumour characteristics and co-morbidity influence treatment choice.
A retrospective cohort analysis of routinely collected cancer registration data from two English regions (West Midlands, Northern & Yorkshire) was carried out (n = 17,129). Trends in surgical use over time for different age groups were assessed graphically and with linear regression. Uni- and multivariable logistic regressions were used to assess the effects of age, comorbidity, deprivation and disease characteristics on treatment choice. Missing data was handled using multiple imputation.
There is no evidence of a change in the proportion of patients treated surgically over time. The multivariable model shows that age remains an important predictor of whether or not a woman with ER+ operable breast cancer receives surgery after covariate adjustment (Odds ratio of surgery vs no surgery, 0.82 (per year over 70)). Co-morbidity, deprivation, symptomatic presentation, later stage at diagnosis and low grade are also associated with increased probability of non-surgical treatment.
Contrary to current NICE guidance in England, age appears to be an important factor in the decision to treat operable ER+ breast cancer non-surgically. Further research is needed to assess the role of other age-related factors on treatment choice, and the effect that current practice has on survival and mortality from breast cancer for older women.
评估自2002年以来，英格兰70岁及以上雌激素受体阳性（ER+）可手术乳腺癌患者接受手术治疗的比例是否发生了变化，并确定年龄以及包括肿瘤特征和合并症在内的个体水平因素是否会影响治疗选择。
对来自英格兰两个地区（西米德兰兹、北部和约克郡）常规收集的癌症登记数据进行回顾性队列分析（n = 17129）。通过图形和线性回归评估不同年龄组随时间推移的手术使用趋势。单变量和多变量逻辑回归用于评估年龄、合并症、贫困程度和疾病特征对治疗选择的影响。使用多重插补处理缺失数据。
没有证据表明随时间推移接受手术治疗的患者比例发生了变化。多变量模型显示，在进行协变量调整后，年龄仍然是ER+可手术乳腺癌女性是否接受手术的重要预测因素（手术与非手术的比值比，70岁以上每年为0.82）。合并症、贫困程度、症状表现、诊断时分期较晚和低级别也与非手术治疗概率增加相关。
与英格兰目前的国家卫生与临床优化研究所（NICE）指南相反，年龄似乎是决定对可手术的ER+乳腺癌进行非手术治疗的一个重要因素。需要进一步研究来评估其他与年龄相关的因素在治疗选择中的作用，以及当前实践对老年女性乳腺癌生存和死亡率的影响。
