Department of Radiation Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Cancer Med. 2020 Nov;9(22):8345-8354. doi: 10.1002/cam4.3443. Epub 2020 Sep 17.
Breast conserving surgery (BCS) and adjuvant hormonal therapy (HT) without radiation therapy (RT) is an acceptable approach for older women with early stage, estrogen receptor (ER) positive breast cancer. Toxicity and compliance remain issues with HT. Adjuvant RT alone may have better compliance, but its efficacy in the absence of HT is unclear. We aim to assess patterns of adjuvant therapy and survival outcomes among older women with early stage, ER positive (ER+) breast cancer.
The National Cancer Data Base (NCDB) was used to identify 130,194 women age ≥65 years with invasive ER+, node negative breast cancer diagnosed between 2004 and 2015. All patients underwent BCS. Kaplan-Meier survival curves were used to examine overall survival (OS). The association between adjuvant therapy and OS was assessed in multivariable Cox proportional hazards regression models.
Unadjusted 5/10-year OS rates were 90.0%/64.3% for HT and RT, 84.2%/54.9% for RT alone, 78.7%/44.5% for HT alone, and 71.6%/38.0% for no treatment; p<0.001 for all. Compared to HT alone, the 10-year multivariable hazard ratio (HR) for death for RT alone was 0.86 (95% CI 0.82-0.91). In propensity-matched patients who received RT alone or HT alone (n=21,326), RT alone had significantly better survival at 5 (HR : 0.84) and 10 (HR : 0.87) years.
Older women with early stage ER+ breast cancer who undergo BCS and receive both HT and RT have the best survival, while RT as single-modality therapy had higher rates of OS at 5 and 10 years compared to HT alone.
对于早期、雌激素受体（ER）阳性的乳腺癌老年女性，保乳手术（BCS）和辅助激素治疗（HT）而不进行放射治疗（RT）是一种可接受的方法。HT 仍存在毒性和依从性问题。单独辅助 RT 可能具有更好的依从性，但在没有 HT 的情况下其疗效尚不清楚。我们旨在评估早期、ER 阳性（ER+）乳腺癌老年女性接受辅助治疗的模式和生存结局。
国家癌症数据库（NCDB）用于确定 2004 年至 2015 年间诊断为浸润性 ER+、淋巴结阴性乳腺癌且年龄≥65 岁的 130194 例女性患者。所有患者均接受了 BCS。采用 Kaplan-Meier 生存曲线评估总生存（OS）。多变量 Cox 比例风险回归模型评估辅助治疗与 OS 的关系。
未经调整的 5/10 年 OS 率分别为 HT+RT 组为 90.0%/64.3%、RT 组为 84.2%/54.9%、HT 组为 78.7%/44.5%、未治疗组为 71.6%/38.0%；所有组间比较均差异有统计学意义（p<0.001）。与 HT 组相比，RT 组的 10 年多变量死亡风险比（HR）为 0.86（95%CI 0.82-0.91）。在接受 RT 或 HT 单独治疗的倾向性匹配患者（n=21326）中，RT 单独治疗在 5 年（HR：0.84）和 10 年（HR：0.87）的生存率显著更高。
接受 BCS 治疗且同时接受 HT 和 RT 的早期 ER+乳腺癌老年女性生存最佳，而 RT 作为单一治疗模式与单独接受 HT 相比，5 年和 10 年的 OS 率更高。
