Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
Pancreatic Center and Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China; Pancreas Institute of Nanjing Medical University, Nanjing, Jiangsu, China.
Clin Breast Cancer. 2019 Feb;19(1):e247-e260. doi: 10.1016/j.clbc.2018.09.007. Epub 2018 Sep 27.
Many elderly breast cancer patients might just receive palliative local surgery, especially those with locally advanced breast cancer (LABC). However, palliative tumor removal might lead to perioperative residual tumor growth. In this study, we aimed to determine the survival effect of palliative local surgery without definitive axillary surgery for LABC in elderly patients.
Patients age 70 years or older diagnosed with T3/4M0 breast cancer, who received no surgery, mastectomy, or lumpectomy without axillary surgery, were identified in the Surveillance, Epidemiology, and End Results cancer database from 1973 to 2014. The overall survival effect of palliative local surgery was determined by using multivariable Cox regression, and propensity score matching was applied to confirm the results.
A total of 2616 female breast cancer patients age 70 years or older diagnosed with T3/4M0 (without inflammatory breast cancer) were identified; 1374 received no cancer-directed surgery, 583 received lumpectomy without axillary surgery, and 659 received mastectomy without axillary surgery. Adjusted for potential confounders, both types of palliative local surgeries (lumpectomy: hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.71-1.27; P = .719; mastectomy: HR, 0.88; 95% CI, 0.65-1.17; P = .371) were not associated with overall survival compared with no surgery within hormone receptor-positive patients. However, mastectomy strongly improved survival within hormone receptor-negative patients. Palliative local surgery did not change the patterns of mortality.
For elderly patients diagnosed with LABC, not candidates for standard therapies, mastectomy should be recommended as palliative therapy for hormone receptor-negative, but not for hormone receptor-positive patients.
许多老年乳腺癌患者可能仅接受姑息性局部手术，尤其是局部晚期乳腺癌（LABC）患者。然而，姑息性肿瘤切除可能导致围手术期残余肿瘤生长。本研究旨在确定对老年局部晚期乳腺癌（LABC）患者行姑息性局部手术而不进行确定性腋窝手术的生存效果。
我们从 1973 年至 2014 年的监测、流行病学和最终结果癌症数据库中确定了年龄 70 岁或以上、诊断为 T3/4M0 乳腺癌、未接受手术、乳房切除术或不进行腋窝手术的保乳切除术的患者。采用多变量 Cox 回归确定姑息性局部手术的总生存效果，并应用倾向评分匹配来验证结果。
共确定了 2616 例年龄 70 岁或以上诊断为 T3/4M0（无炎性乳腺癌）的女性乳腺癌患者；1374 例患者未行癌症定向手术，583 例患者行保乳切除术且未行腋窝手术，659 例患者行乳房切除术且未行腋窝手术。在调整了潜在混杂因素后，两种姑息性局部手术（保乳切除术：风险比[HR]，0.95；95%置信区间[CI]，0.71-1.27；P=0.719；乳房切除术：HR，0.88；95%CI，0.65-1.17；P=0.371）与激素受体阳性患者中的无手术相比，均与总生存无关。然而，乳房切除术在激素受体阴性患者中显著改善了生存。姑息性局部手术并未改变死亡率模式。
对于不适合标准治疗的老年局部晚期乳腺癌患者，对于激素受体阴性患者，应推荐乳房切除术作为姑息性治疗方法，但不推荐用于激素受体阳性患者。
