Cabrera-Galeana Paula, Soto-Perez-de-Celis Enrique, Reynoso-Noveron Nancy, Villarreal-Garza Cynthia, Lara-Medina Fernando, Alvarado-Miranda Alberto, Espinosa-Fernandez José Rodrigo, Esparza-Arias Nereida, Mohar Alejandro, Bargallo-Rocha Juan Enrique
Departamento de Oncología Médica-Tumores Mamarios, Instituto Nacional de Cancerología, Mexico City, Mexico.
Programa de Atención a Pacientes Post-Mastectomía, Instituto Nacional de Cancerología, Mexico City, Mexico.
Oncologist. 2020 Dec;25(12):1023-1031. doi: 10.1634/theoncologist.2019-0891. Epub 2020 Apr 28.
Older patients with breast cancer treated in high-income countries often present with early-stage disease, leading to a lack of information on the use of neoadjuvant chemotherapy in this population. We analyzed the real-world outcomes of older women with breast cancer treated with neoadjuvant chemotherapy at a single institution in Mexico.
The study included 2,216 patients treated with neoadjuvant chemotherapy. Regarding achievement of pathologic complete response (defined as no invasive residual tumor in the breast and lymph nodes), 243 patients aged ≥65 years were compared with 1,973 patients aged <65 years. Disease-free survival and overall survival were compared between groups according to pathologic complete response and subtype, defined by hormone receptor and human epidermal growth receptor 2 (HER2) status.
Older women were less likely to have a pathologic complete response than their younger counterparts (26.3 vs. 35.3%, p < .001). When response rates by subtype were analyzed, this difference was significant only for women with triple-negative tumors. Achieving less than a pathologic complete response was associated with a greater chance of recurrence, but age was not an independent factor for recurrence for any subtype. Reaching a pathologic complete response was significantly associated with improved survival among older women with breast cancer, with the exception of those with hormone receptor-positive, HER2- disease.
Although older women have fewer pathological complete responses, their outcomes after neoadjuvant chemotherapy are comparable to those of younger patients. This is particularly relevant for the treatment of older adults with breast cancer in developing countries, who present in advanced stages and more often need neoadjuvant therapy.
The majority of older patients with breast cancer in high-income countries present with early-stage disease, leading to a lack of information regarding the use of neoadjuvant chemotherapy in real-world settings. This article reports the outcomes of older Mexican women with breast cancer who received neoadjuvant chemotherapy compared with their younger counterparts. Although older women (particularly those with triple-negative tumors) were less likely to have a pathologic complete response after neoadjuvant treatment, age was not an independent factor for recurrence. Achieving a pathologic complete response was associated with improved survival, regardless of age.
在高收入国家接受治疗的老年乳腺癌患者通常表现为早期疾病，导致缺乏该人群新辅助化疗使用情况的信息。我们分析了在墨西哥一家机构接受新辅助化疗的老年乳腺癌女性的真实世界结局。
该研究纳入了2216例接受新辅助化疗的患者。关于病理完全缓解（定义为乳腺和淋巴结中无浸润性残留肿瘤）的实现情况，将243例年龄≥65岁的患者与1973例年龄<65岁的患者进行了比较。根据病理完全缓解和亚型（由激素受体和人表皮生长受体2（HER2）状态定义）在组间比较无病生存期和总生存期。
老年女性获得病理完全缓解的可能性低于年轻女性（26.3%对35.3%，p<.001）。在分析各亚型的缓解率时，这种差异仅在三阴性肿瘤女性中显著。获得低于病理完全缓解与更高的复发机会相关，但年龄不是任何亚型复发的独立因素。在老年乳腺癌女性中，达到病理完全缓解与生存期改善显著相关，但激素受体阳性、HER2阴性的患者除外。
尽管老年女性的病理完全缓解较少，但她们新辅助化疗后的结局与年轻患者相当。这对于发展中国家晚期就诊且更常需要新辅助治疗的老年乳腺癌患者的治疗尤为重要。
高收入国家的大多数老年乳腺癌患者表现为早期疾病，导致缺乏真实世界中使用新辅助化疗的信息。本文报告了接受新辅助化疗的墨西哥老年乳腺癌女性与年轻女性相比的结局。尽管老年女性（尤其是三阴性肿瘤患者）新辅助治疗后获得病理完全缓解的可能性较小，但年龄不是复发的独立因素。无论年龄如何，达到病理完全缓解都与生存期改善相关。
