Department of Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK.
Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
Br J Surg. 2018 Oct;105(11):1454-1463. doi: 10.1002/bjs.10885. Epub 2018 May 22.
Primary endocrine therapy is used as an alternative to surgery in up to 40 per cent of women with early breast cancer aged over 70 years in the UK. This study investigated the impact of surgery versus primary endocrine therapy on breast cancer-specific survival (BCSS) in older women.
Cancer registration data for 2002-2010 were obtained from two English regions. A retrospective analysis was performed for women with oestrogen receptor (ER)-positive disease, using statistical modelling to show the effect of treatment (surgery or primary endocrine therapy) and age and health status on BCSS. Missing data were handled using multiple imputation.
Cancer registration data on 23 961 women were retrieved. After data preprocessing, 18 730 of 23 849 women (78·5 per cent) were identified as having ER-positive disease; of these, 10 087 (53·9 per cent) had surgery and 8643 (46·1 per cent) had primary endocrine therapy. BCSS was worse in the primary endocrine therapy group than in the surgical group (5-year BCSS rate 69·4 and 89·9 per cent respectively). This was true for all strata considered, although the difference was less in the cohort with the greatest degree of co-morbidity. For older, frailer patients the hazard of breast cancer death had less relative impact on overall survival.
BCSS in older women with ER-positive disease is worse if surgery is omitted. This treatment choice may contribute to inferior cancer outcomes. Selection for surgery on the basis of predicted life expectancy may permit choice of women for whom surgery confers little benefit.
在英国，高达 40%的 70 岁以上早期乳腺癌女性选择内分泌治疗作为手术的替代方案。本研究旨在探讨手术与原发性内分泌治疗对老年女性乳腺癌特异性生存（BCSS）的影响。
从英国的两个地区获取了 2002-2010 年的癌症登记数据。对雌激素受体（ER）阳性疾病的女性进行回顾性分析，使用统计模型显示治疗（手术或原发性内分泌治疗）、年龄和健康状况对 BCSS 的影响。使用多次插补处理缺失数据。
共检索到 23849 名女性的癌症登记数据。经过数据预处理，18730 名 23849 名女性中有 18730 名（78.5%）被确定为 ER 阳性疾病；其中 10087 名（53.9%）接受了手术，8643 名（46.1%）接受了原发性内分泌治疗。原发性内分泌治疗组的 BCSS 明显差于手术组（5 年 BCSS 率分别为 69.4%和 89.9%）。这在所有考虑的分层中都是如此，尽管在合并症最多的队列中差异较小。对于年龄较大、身体虚弱的患者，乳腺癌死亡的风险对总生存的相对影响较小。
对于 ER 阳性疾病的老年女性，如果不进行手术，BCSS 较差。这种治疗选择可能导致癌症预后较差。基于预期寿命的手术选择可能允许选择对手术获益较小的女性。
