Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Cancer. 2020 Mar 15;126(6):1193-1201. doi: 10.1002/cncr.32668. Epub 2019 Dec 20.
Despite data demonstrating the safety of omitting axillary surgery in older women with early-stage breast cancer, the incidence of axillary surgery remains high. It was hypothesized that the prevalence of nodal positivity would decrease with advancing age.
The National Cancer Data Base was used to construct a cohort of adult women with early-stage, clinically node-negative, estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative breast cancer treated between 2013 and 2015. Multivariable logistic regression was used to assess the relationship between age and nodal positivity, and this was stratified by the axillary surgery category. Modified Poisson regression was used to estimate the proportion of women receiving adjuvant therapy according to age and nodal status.
The incidence of axillary surgery among women aged 70 and older (n = 51,917) remained high nationwide (86%). There was a significant decrease in nodal positivity with advancing age in women with early-stage, ER+, clinically node-negative breast cancer from the youngest cohort up to patients aged 70 to 89 years, and this was independent of histologic subtype (ductal vs lobular), race, comorbidities, and socioeconomic factors. Overall, less than 10% of women aged 70 or older who underwent surgery had node-positive disease, regardless of axillary surgery type, and almost 95% of node-positive patients aged 70 or older were at pathological stage N1mi or N1.
Axillary surgery may be safely omitted for many older women with ER+, clinically node-negative, early-stage breast cancer. Nodal positivity declines with advancing age, and this suggests varied biology in older patients versus younger patients.
尽管有数据表明在早期乳腺癌的老年女性中省略腋窝手术是安全的，但腋窝手术的发生率仍然很高。据推测，随着年龄的增长，淋巴结阳性的比例会降低。
使用国家癌症数据库构建了一个队列，纳入了 2013 年至 2015 年间接受治疗的、患有早期、临床淋巴结阴性、雌激素受体阳性（ER+）、人表皮生长因子受体 2 阴性的乳腺癌的成年女性。多变量逻辑回归用于评估年龄与淋巴结阳性之间的关系，并按腋窝手术类别进行分层。采用修正泊松回归估计根据年龄和淋巴结状态接受辅助治疗的女性比例。
在全国范围内，70 岁及以上（n=51917）的女性进行腋窝手术的比例仍然很高（86%）。在患有早期、ER+、临床淋巴结阴性乳腺癌的女性中，随着年龄的增长，淋巴结阳性率呈显著下降趋势，从最年轻的队列到 70 至 89 岁的患者，这与组织学亚型（导管或小叶）、种族、合并症和社会经济因素无关。总体而言，无论腋窝手术类型如何，70 岁或以上接受手术的女性中不到 10%患有淋巴结阳性疾病，而 70 岁或以上的淋巴结阳性患者中几乎有 95%处于病理分期 N1mi 或 N1。
对于许多患有 ER+、临床淋巴结阴性、早期乳腺癌的老年女性，可能可以安全地省略腋窝手术。淋巴结阳性率随着年龄的增长而降低，这表明老年患者与年轻患者的生物学特征不同。
