van der Leij Femke, van Werkhoven Erik, Bosma Sophie, Linn Sabine C, Rutgers Emiel J, van de Vijver Marc J, Bartelink Harry, Elkhuizen Paula H M, Scholten Astrid
Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Statistics Department, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Breast. 2016 Dec;30:19-25. doi: 10.1016/j.breast.2016.08.004. Epub 2016 Aug 29.
To guide decision making in preventing over- or under-treatment in older breast cancer patients who have undergone breast conserving surgery, we analyzed prognostic factors and risk of recurrence in a consecutive series of patients ≥ 65 years old with breast cancer and identified subgroups that may benefit or not from more intensive treatment.
Patients ≥65 years of age with breast cancer (pT1-2/pN0-2) treated with breast conserving surgery and postoperative radiation therapy at the Netherlands Cancer Institute (NKI) between 1980 and 2008 were identified. Endpoints were locoregional recurrence (LRR), distant metastasis (DM) and overall survival (OS). Multivariable analyses were performed using Cox proportional hazards models.
1922 patients with a median age of 70 years were analyzed. The 5- and 10- years LRR rates were 2% and 3% respectively. In multivariable analysis there was no significant factor influencing LRR risk. Patients with low risk tumors (node negative patients with T1 and ER positive, grade 1 or 2) had lower risk of DM (HR 0.26) and better OS (HR 0.65) compared to patients with higher risk tumors (grade 3 and/or node positive).
In elderly breast cancer patients the risk of LRR and DM is low. In patients with less favorable characteristics the risk of LRR is equally low, with a higher risk to develop DM and worse OS. Treatment in the low risk group may be minimized, while for the higher risk group adjuvant treatment could be intensified.
为指导老年乳腺癌保乳手术患者避免过度治疗或治疗不足的决策，我们分析了一系列连续的65岁及以上乳腺癌患者的预后因素和复发风险，并确定了可能从强化治疗中获益或未获益的亚组。
确定1980年至2008年期间在荷兰癌症研究所（NKI）接受保乳手术和术后放疗的65岁及以上乳腺癌（pT1-2/pN0-2）患者。终点指标为局部区域复发（LRR）、远处转移（DM）和总生存期（OS）。使用Cox比例风险模型进行多变量分析。
分析了1922例中位年龄为70岁的患者。5年和10年的LRR率分别为2%和3%。在多变量分析中，没有显著因素影响LRR风险。与高风险肿瘤患者（3级和/或淋巴结阳性）相比，低风险肿瘤患者（T1期淋巴结阴性且ER阳性、1级或2级）发生DM的风险较低（HR 0.26），OS较好（HR 0.65）。
老年乳腺癌患者LRR和DM风险较低。特征较差的患者LRR风险同样较低，但发生DM的风险较高，OS较差。低风险组的治疗可降至最低，而高风险组可强化辅助治疗。
