Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
J Cancer Res Clin Oncol. 2020 Jul;146(7):1791-1800. doi: 10.1007/s00432-020-03243-5. Epub 2020 May 13.
To assess the impact of age, comorbidities and endocrine therapy (ET) in older breast cancer (BC) patients treated with hypofractionated radiotherapy (Hypo-RT).
From June 2009 to December 2017, we enrolled in this study 735 ER-positive BC patients (stage pT1-T2, pNx-1, M0 and age ≥ 65 years) receiving hypo-RT and followed them until September 2019. Baseline comorbidities included in the hypertension-augmented Charlson Comorbidity Index were retrospectively retrieved. Logistic regression model estimated adjusted-odds ratios (ORs) of ET prescription in relation to baseline patient and tumor characteristics. Competing risk analysis estimated 5-year cumulative incidence function (CIF) of ET discontinuation due to side effects (with BC progression or death as competing events), and its effect on locoregional recurrence (LRR) and distant metastasis (DM) (with death as competing event).
ET has been prescribed in 89% patients. In multivariable analysis, the odds of ET prescription was significantly reduced in older patients (≥ 80 years, OR 0.08, 95% CI 0.03-0.20) and significantly increased in patients with moderate comorbidity. Patients ≥ 80 years discontinued the prescribed therapy earlier and more frequently than younger (65-69 years) patients (p = 0.060). Five-year CIF of LLR, DM and death from causes other that BC were 1.7%, 2.2% and 7.5%, respectively. Patients who discontinued ET had higher chance of LRR (p = 0.004). ET use did not impact on OS in any of the analyzed groups.
In older patients, ET did not show a benefit in terms of overall survival. Further studies focusing on tailored treatment approaches are warranted to offer the best care in terms of adjuvant treatment to these patients.
评估年龄、合并症和内分泌治疗（ET）对接受低分割放疗（Hypo-RT）的老年乳腺癌（BC）患者的影响。
本研究纳入了 2009 年 6 月至 2017 年 12 月期间接受 Hypo-RT 的 735 例 ER 阳性 BC 患者（pT1-T2、pNx-1、M0 且年龄≥65 岁），并随访至 2019 年 9 月。回顾性检索高血压增强 Charlson 合并症指数中的基线合并症。使用逻辑回归模型估计 ET 处方与基线患者和肿瘤特征的调整比值比（OR）。竞争风险分析估计了 5 年 ET 因副作用停药的累积发生率函数（CIF）（以 BC 进展或死亡为竞争事件），以及其对局部区域复发（LRR）和远处转移（DM）（以死亡为竞争事件）的影响。
89%的患者接受了 ET 治疗。多变量分析显示，年龄较大（≥80 岁，OR 0.08，95%CI 0.03-0.20）和合并症中等的患者接受 ET 治疗的可能性显著降低。≥80 岁的患者比 65-69 岁的患者更早、更频繁地停止规定的治疗（p=0.060）。5 年 LRR、DM 和非 BC 原因死亡的 CIF 分别为 1.7%、2.2%和 7.5%。停止 ET 治疗的患者发生 LRR 的可能性更高（p=0.004）。在任何分析组中，ET 的使用都没有对 OS 产生影响。
在老年患者中，ET 在总生存方面没有获益。需要进一步的研究来关注针对这些患者的个体化治疗方法，为他们提供最佳的辅助治疗。
