Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
J Geriatr Oncol. 2018 Nov;9(6):635-641. doi: 10.1016/j.jgo.2018.05.004. Epub 2018 May 18.
Clinical trials investigating breast cancer treatment often exclude or misrepresent older adults. This study compares treatment patterns and survival of older women diagnosed with breast cancer between a Dutch and a British observational cohort.
Women aged 70 years and older diagnosed with breast cancer after 1990 with a T0-T2 tumor stage and no evidence of metastatic disease were included from a population-based cohort in the Netherlands and a British hospital-based cohort in Nottingham. Main outcomes were proportions of local and systemic treatment, ten-year overall survival and ten-year relative survival for each cohort.
1439 patients from Nottingham and 2180 patients from the Netherlands were included. Median follow-up was 12.4 years (IQR 11.0-14.0) in the FOCUS cohort and 6.4 years (IQR 6.2-6.8) in the Nottingham cohort. British patients were more likely to receive primary endocrine therapy (50.0% vs 7.5%, P < 0.001), and less likely to be managed with mastectomy or breast-conserving surgery (47.8% vs 90.5%, P < 0.001). Ten-years overall survival was 39.4% (95% CI 37.4-41.6%) in the FOCUS cohort and 34.3% (95% CI 30.7-38.3) in the Nottingham cohort (adjusted HR 0.97, 95% CI 0.87-1.08, P = 0.559). Ten-year relative survival was 82.5% (95% CI 75.6-90.1) in the FOCUS cohort and 77.6% (95% CI 66.4-90.7) in the Nottingham cohort (adjusted relative excess risk 1.67, 95% CI 1.21-2.29, P = 0.002).
Patients in the Nottingham cohort were more likely to receive primary endocrine therapy and had worse relative survival compared to the Dutch cohort. These findings encourage further research to equalize survival rates of breast cancer throughout Europe.
针对乳腺癌治疗的临床试验通常排除或歪曲老年人的情况。本研究比较了荷兰和英国观察性队列中诊断为乳腺癌的老年女性的治疗模式和生存情况。
纳入了荷兰基于人群的队列和英国诺丁汉基于医院的队列中 1990 年后诊断为 T0-T2 肿瘤分期且无转移疾病证据的年龄在 70 岁及以上的女性。主要结局为每个队列的局部和全身治疗比例、十年总生存率和十年相对生存率。
共纳入了来自诺丁汉的 1439 名患者和来自荷兰的 2180 名患者。FOCUS 队列的中位随访时间为 12.4 年（IQR 11.0-14.0），诺丁汉队列为 6.4 年（IQR 6.2-6.8）。英国患者更有可能接受初始内分泌治疗（50.0% vs 7.5%，P<0.001），而接受乳房切除术或保乳手术的可能性较小（47.8% vs 90.5%，P<0.001）。FOCUS 队列的十年总生存率为 39.4%（95%CI 37.4-41.6%），诺丁汉队列为 34.3%（95%CI 30.7-38.3%）（调整后的 HR 0.97，95%CI 0.87-1.08，P=0.559）。FOCUS 队列的十年相对生存率为 82.5%（95%CI 75.6-90.1），诺丁汉队列为 77.6%（95%CI 66.4-90.7）（调整后的相对超额风险 1.67，95%CI 1.21-2.29，P=0.002）。
与荷兰队列相比，诺丁汉队列的患者更有可能接受初始内分泌治疗，且相对生存率较差。这些发现鼓励进一步研究，以平等化整个欧洲的乳腺癌生存率。
