Kaplan Henry G, Malmgren Judith A, Atwood Mary K
Swedish Cancer Institute, Seattle, WA, USA.
HealthStat Consulting, Inc., Seattle, WA, USA.
Breast J. 2017 Nov;23(6):630-637. doi: 10.1111/tbj.12813. Epub 2017 May 9.
Our objective is to characterize treatment of triple-negative breast cancer (TNBC) in older patients and measure mortality risk relative to younger women. We conducted a retrospective cohort study analysis of patients presenting with primary TNBC, age 25-93, stage I-III from 1990 to 2014, identified and tracked by our registry (n=771). Clinical characteristics were chart abstracted at diagnosis and follow-up. The Kaplan-Meier method was used to measure disease-specific survival (DSS) by age with Cox regression modeling for relative contribution of patient and clinical characteristics. Of patients, 80% were <65 years (n=612), 13% were 65-74 years (n=100), and 7% were 75 and older (n=59). Older women presented more often with lower stage BC (stage I: 31% age <65, 48% age 65-74, 39% age 75+; P=.014). All three age groups were equally likely to have radiation therapy (77%) but older patients were less often treated with adjuvant chemotherapy (<65=95%, 65-74=76%, 75+=39%; P<.001). Mean follow-up was 7.34 years and did not differ by age. Five-year DSS was equivalent across the three age groups (<65=85%, 65-74=90%, 75+=83%, P=.322). In Cox regression analysis controlling for stage, histologic and nuclear grade, diagnosis year, radiation and chemotherapy treatment, age was not significantly associated with disease-specific mortality. TNBC survival appears equivalent by age despite less aggressive treatment in patients 75 years and older. This may be a result of lower stage at diagnosis and decreased disease virulence resulting in comparative survival despite less treatment.
我们的目标是描述老年患者三阴性乳腺癌(TNBC)的治疗情况,并衡量相对于年轻女性的死亡风险。我们对1990年至2014年间年龄在25 - 93岁、患有I - III期原发性TNBC的患者进行了一项回顾性队列研究分析,这些患者由我们的登记处识别并跟踪(n = 771)。临床特征在诊断和随访时从病历中提取。采用Kaplan - Meier方法按年龄测量疾病特异性生存率(DSS),并使用Cox回归模型分析患者和临床特征的相对贡献。患者中,80%年龄小于65岁(n = 612),13%年龄在65 - 74岁(n = 100),7%年龄在75岁及以上(n = 59)。老年女性更常表现为较低分期的乳腺癌(I期:年龄小于65岁者为31%,年龄在65 - 74岁者为48%,年龄在75岁及以上者为39%;P = 0.014)。所有三个年龄组接受放射治疗的可能性相同(77%),但老年患者接受辅助化疗的频率较低(年龄小于65岁者为95%,年龄在65 - 74岁者为76%,年龄在75岁及以上者为39%;P < 0.001)。平均随访时间为7.34年,且各年龄组无差异。三个年龄组的五年DSS相当(年龄小于65岁者为85%,年龄在65 - 74岁者为90%,年龄在75岁及以上者为83%,P = 0.322)。在控制分期、组织学和核分级、诊断年份、放射和化疗治疗的Cox回归分析中,年龄与疾病特异性死亡率无显著关联。尽管75岁及以上患者的治疗强度较低,但TNBC的生存率按年龄来看似乎相当。这可能是由于诊断时分期较低以及疾病毒力降低,导致尽管治疗较少但生存率仍具可比性。
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