Thomas R, Pieri A, Cain H
Queen Elizabeth Hospital, Gateshead NHS Foundation Trust, Queen Elizabeth Avenue, Gateshead, NE9 6SX, UK.
North Tees and Hartlepool NHS Foundation Trust, Hardwick Rd, Stockton on Tees, TS19 8PE, UK.
Eur J Surg Oncol. 2017 Oct;43(10):1816-1827. doi: 10.1016/j.ejso.2017.06.014. Epub 2017 Jul 18.
The use of primary endocrine therapy (PET) in managing breast cancer in the elderly has become common practice. Whilst there appears to be no difference in overall survival in comparison with surgery, PET has been found to be inferior in local disease control with a limited duration of efficacy (2-3 years). The International Society of Geriatric Oncology (SIOG) state that PET may be considered in patients with a short life expectancy (<2 years) or considered unfit for surgery. Frequently, decision making for PET allocation is a subjective process by the clinician.
A systematic literature review was performed to establish what prediction models are available for all-cause mortality in the elderly, and what breast-specific models have been produced.
18 prognostic models were deemed eligible from 15 papers. 1 breast-specific model was found, 2 nursing home related and 15 for community-dwelling elders. Accuracy (as defined by discrimination; c-statistic or AUROC) ranged from 0.69 (moderate) to 0.86 (very good).
This review highlighted a variety of validated prognostic indexes. Several models with very good accuracy were identified but most were validated in US-populations and relied on information from administrative datasets. One breast specific model by Stotter et al. was identified, specifically to aid treatment planning for frail elderly patients but had limited accuracy. The strength of an index will ultimately be on its clinical impact and influence on treatment decisions rather than its accuracy and as of yet no trials exploring this have been carried out.
在老年乳腺癌管理中使用一线内分泌治疗（PET）已成为常见做法。虽然与手术相比总体生存率似乎没有差异，但已发现PET在局部疾病控制方面较差，疗效持续时间有限（2 - 3年）。国际老年肿瘤学会（SIOG）指出，预期寿命短（<2年）或不适合手术的患者可考虑使用PET。通常，PET分配的决策是临床医生的主观过程。
进行系统的文献综述，以确定有哪些适用于老年人全因死亡率的预测模型，以及已产生哪些乳腺癌特异性模型。
从15篇论文中筛选出18个预后模型符合要求。发现1个乳腺癌特异性模型，2个与养老院相关的模型，以及15个针对社区居住老年人的模型。准确性（以区分度定义；c统计量或受试者工作特征曲线下面积）范围为0.69（中等）至0.86（非常好）。
本综述强调了多种经过验证的预后指标。确定了几个准确性非常高的模型，但大多数在美国人群中得到验证，且依赖行政数据集的信息。确定了Stotter等人的一个乳腺癌特异性模型，专门用于帮助体弱老年患者的治疗规划，但准确性有限。一个指标的优势最终将体现在其临床影响和对治疗决策的影响上，而非其准确性，目前尚未进行探索这一点的试验。
