Ward Erin P, Weiss Anna, Blair Sarah L
Moores Cancer Center, University of California, 3855 Heath Science Dr, MC 0987, La Jolla, San Diego, CA, 92093-0987, USA.
Department of Breast Surgery, MD Anderson, Houston, TX, 77930, USA.
Breast Cancer Res Treat. 2017 Sep;165(2):403-409. doi: 10.1007/s10549-017-4330-5. Epub 2017 Jun 12.
The purpose of this study is to better characterize the current incidence and treatment patterns of DCIS in women greater than 80 years of age (>80) and to evaluate the effect of grade on treatment efficacy.
Retrospective observational study of women diagnosed with single primary DCIS from 2000 to 2012 in SEER. Statistics including incidence, multivariable Cox proportional hazards model and subset analysis were performed.
42,899 female patients with DCIS were identified, 2566 (5.98%) were >80. Incidence of DCIS in the less than 80 (<80) cohort was 8 per 100,000 and 11.7 per 100,000 for >80. >80 patients have a similar incidence of high grade DCIS (9.8%) as compared to <80 cohort (10.7%, P = 0.246). Compared to the <80 population the >80 population received significantly less surgery (97 vs. 92%, P < 0.001) and radiation (22 vs. 47%, P < 0.001). Although on multivariate analysis surgery did not provide a survival benefit for >80 population, it conveyed a survival benefit for high grade DCIS (HR 0.14, 95% CI 02-0.68) that was not observed for low grade DCIS (HR 0.46, 95% CI 0.1-2.03).
Patients over 80 years of age have a relatively high incidence of DCIS and receive low relative rates of treatment. Although surgery does not provide a survival benefit for all patients over 80, it does provide a significant survival benefit for patients with high grade DCIS. Our results suggest that perhaps the biology of the DCIS, not the age of the patient should direct who warrants treatment.
本研究旨在更好地描述80岁以上（>80）女性导管原位癌（DCIS）的当前发病率和治疗模式，并评估分级对治疗效果的影响。
对2000年至2012年在监测、流行病学和最终结果（SEER）中诊断为单一原发性DCIS的女性进行回顾性观察研究。进行了包括发病率、多变量Cox比例风险模型和亚组分析在内的统计。
共识别出42899例DCIS女性患者，其中2566例（5.98%）年龄>80岁。80岁以下（<80）队列中DCIS的发病率为每10万人8例，80岁以上为每10万人11.7例。80岁以上患者高级别DCIS的发病率（9.8%）与80岁以下队列（10.7%，P = 0.246）相似。与80岁以下人群相比，80岁以上人群接受手术的比例显著更低（97%对92%，P < 0.001）和放疗的比例也显著更低（22%对47%，P < 0.001）。尽管多变量分析显示手术对80岁以上人群没有生存益处，但对于高级别DCIS它具有生存益处（风险比[HR] 0.14，95%置信区间[CI] 0.02 - 0.68），而低级别DCIS未观察到这种益处（HR 0.46，95% CI 0.1 - 2.03）。
80岁以上患者DCIS发病率相对较高，但接受治疗的相对比例较低。尽管手术对所有80岁以上患者没有生存益处，但对高级别DCIS患者有显著的生存益处。我们的结果表明，或许DCIS的生物学特性而非患者年龄应指导哪些患者需要接受治疗。
