General and Digestive Surgery Dept, Castellon General Hospital, Spain.
General and Digestive Surgery Dept, Castellon General Hospital, Spain.
Breast. 2018 Apr;38:81-85. doi: 10.1016/j.breast.2017.12.007. Epub 2018 Jan 4.
The number of old people with breast cancer is estimated to increase during the next years in developed countries. However, management of breast cancer in octogenarians is not well established. The main objective was to evaluate if patients older than 80 years with breast cancer are receiving the most convenient treatment by using a population registry cancer analysis.
A retrospective analysis of a population cancer registry was designed. Data were retrieved from the Castellon Cancer Registry (Valencian Community, Spain). Patient records were analyzed from January 1, 1995 to December 31, 2013. Two groups were defined: group A, <80 years; and group B, >= 80 years. Survival analyses were sequentially performed into three phases. First, a non-adjusted Kaplan Meier analysis was conducted. For the second survival analyses, Cox's proportional hazards model of Overall survival was used adjusting for condensed-TNM stage and adjuvant treatments. Finally, the third specific adjustment was carried out adding information of life expectancy by age for Spanish women, corresponding to year 2008 with condensed-TNM stage and Propensity Score variable, as an approximation to relative or disease-specific survival.
The total number of included patients was 1304. Women ≥80 years presented a more extended disease, larger tumors and less in situ carcinomas. A lower proportion of women ≥80 years received adjuvant therapies. In the absence of any adjustment of results, the overall survival in women ≥80 years was poorer than in younger patients (median of 14.1 years for <80y vs. 5.7 years for ≥80y), the crude HR was 4.6 (95% CI: 2.9-7.5) p < 0.001. For second survival analysis, the HR was 2.5 (95% CI: 1.8-3.5) p < 0.001. After the third adjustment the HR was 1.7 (95% CI: 1.2-2.4) p = 0.004.
Octogenarians with operable breast cancer are receiving suboptimal treatments, which can have repercussions on survival. New studies are required to identify a subgroup of women age ≥80 years who may benefit from more aggressive treatment and a population of older women on the basis of tumor characteristics, comorbidities and life expectancy who may not need as aggressive treatment.
预计在未来几年，发达国家的老年乳腺癌患者人数将会增加。然而，对于 80 岁以上的老年乳腺癌患者的管理尚不完善。本主要目的是通过人群癌症登记分析评估 80 岁以上的乳腺癌患者是否接受了最恰当的治疗。
设计了一项人群癌症登记的回顾性分析。数据来自西班牙瓦伦西亚社区的卡斯特利翁癌症登记处。分析了 1995 年 1 月 1 日至 2013 年 12 月 31 日的患者记录。将患者分为两组：A 组，<80 岁；B 组，>=80 岁。依次进行了生存分析的三个阶段。首先，进行了非调整的 Kaplan-Meier 分析。其次，使用整体生存的 Cox 比例风险模型，对浓缩-TNM 分期和辅助治疗进行调整。最后，进行了第三次特定调整，加入了西班牙女性预期寿命的信息，对应于 2008 年的浓缩-TNM 分期和倾向评分变量，作为相对或疾病特异性生存的近似值。
共纳入 1304 名患者。80 岁及以上的女性患者肿瘤更大，更晚期，原位癌比例较低。接受辅助治疗的患者比例较低。在未对结果进行任何调整的情况下，80 岁及以上女性患者的总体生存率较年轻患者差（<80 岁的中位生存时间为 14.1 年，而≥80 岁的中位生存时间为 5.7 年），粗 HR 为 4.6（95%CI：2.9-7.5）p<0.001。第二次生存分析中，HR 为 2.5（95%CI：1.8-3.5）p<0.001。第三次调整后的 HR 为 1.7（95%CI：1.2-2.4）p=0.004。
可手术的 80 岁以上老年乳腺癌患者接受的治疗并不理想，这可能对生存产生影响。需要进行新的研究，以确定一组年龄在 80 岁以上的女性患者可能受益于更积极的治疗，同时还需要根据肿瘤特征、合并症和预期寿命确定一组年龄较大的女性患者，她们可能不需要如此积极的治疗。
