Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Department of Surgery, Park Surgrcal Clinic, Suwon, Korea.
Breast Cancer Res Treat. 2019 Dec;178(3):693-701. doi: 10.1007/s10549-019-05426-2. Epub 2019 Sep 6.
The aim of this study was to investigate the therapeutic efficacy of adjuvant modalities for elderly Asian breast cancer patients using population-based data from the Korean Breast Cancer Registry database.
We identified 53,582 patients who underwent curative surgery between January 2005 and December 2010. The primary end point was the comparison of overall survival between the administration or omission of adjuvant treatment modalities, including endocrine treatment, radiation therapy, and chemotherapy, in the elderly group (older than 75 years) compared with the control group (younger than 75 years).
Of the 53,582 patients analyzed, the total number of elderly patients was 901 (1.7%), and the number of control patients was 52,681 (98.3%). Although elderly patients were found to have larger tumor sizes (p = 0.024) and higher pathological stages (p < 0.001) than the control group, elderly patients were less likely to undergo adjuvant treatment compared to the control group. However, use of endocrine treatment in elderly patients with HR-positive breast cancer is associated with improved overall survival (OS) (adjusted OR 0.417; 95% confidence interval [CI] 0.240-0.726; p = 0.002). Furthermore, chemotherapy was associated with a significant improvement in OS in patients with stage II and III breast cancer (adjusted OR 0.657; 95% CI 0.462-0.934; p = 0.019).
Endocrine treatment and chemotherapy for elderly patients are associated with improved OS. Therefore, personalized decision-making based on the potential survival benefit of adjuvant treatment modalities should be made with the careful counseling of all elderly patients with breast cancer.
本研究旨在利用韩国乳腺癌登记数据库中的基于人群的数据，调查辅助治疗方式对老年亚洲乳腺癌患者的疗效。
我们确定了 53582 例于 2005 年 1 月至 2010 年 12 月期间接受根治性手术的患者。主要终点是比较老年组（年龄大于 75 岁）与对照组（年龄小于 75 岁）中辅助治疗方式（内分泌治疗、放疗和化疗）的应用或省略对总生存的影响。
在分析的 53582 例患者中，老年患者总数为 901 例（1.7%），对照组为 52681 例（98.3%）。尽管老年患者的肿瘤大小（p=0.024）和病理分期（p<0.001）均大于对照组，但与对照组相比，老年患者接受辅助治疗的可能性较小。然而，HR 阳性乳腺癌老年患者使用内分泌治疗与总生存（OS）改善相关（调整后的 OR 0.417；95%置信区间 [CI] 0.240-0.726；p=0.002）。此外，化疗与 II 期和 III 期乳腺癌患者 OS 显著改善相关（调整后的 OR 0.657；95%CI 0.462-0.934；p=0.019）。
内分泌治疗和化疗可改善老年患者的 OS。因此，应根据辅助治疗方式的潜在生存获益，对所有老年乳腺癌患者进行个体化决策，并进行谨慎的咨询。
