Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Br J Surg. 2021 Mar 12;108(2):160-167. doi: 10.1093/bjs/znaa042.
Studies reporting lower rates of surgery for older women with early invasive breast cancer have focused on women with oestrogen receptor (ER)-positive tumours. This study examined the factors that influence receipt of breast surgery in older women with ER-positive and ER-negative early invasive breast cancer .
Women aged 50 years or above with unilateral stage 1-3A early invasive breast cancer diagnosed in 2014-2017 were identified from linked English and Welsh cancer registration and routine hospital data sets. Logistic regression analysis was used to evaluate the influence of tumour and patient factors on receipt of surgery.
Among 83 188 women, 86.8 per cent had ER-positive and 13.2 per cent had ER-negative early invasive breast cancer. These proportions were unaffected by age at diagnosis. Compared with women with ER-negative breast cancer, a higher proportion of women with ER-positive breast cancer presented with low risk tumour characteristics: G1 (20.0 versus 1.5 per cent), T1 (60.8 versus 44.2 per cent) and N0 (73.9 versus 68.8 per cent). The proportions of women with any recorded co-morbidity (13.7 versus 14.3 per cent) or degree of frailty (25 versus 25.8 per cent) were similar among women with ER-positive and ER-negative disease respectively. In women with ER-positive early invasive breast cancer aged 70-74, 75-79 and 80 years or above, the rate of no surgery was 5.6, 11.0 and 41.9 per cent respectively. Among women with ER-negative early invasive breast cancer, the corresponding rates were 3.8, 3.7 and 12.3 per cent. The relatively lower rate of surgery for ER-positive breast cancer persisted in women with good fitness.
The reasons for the observer differences should be further explored to ensure consistency in treatment decisions.
报告雌激素受体（ER）阳性早期浸润性乳腺癌老年女性手术率较低的研究集中在 ER 阳性肿瘤患者上。本研究探讨了影响 ER 阳性和 ER 阴性早期浸润性乳腺癌老年女性接受乳房手术的因素。
从 2014 年至 2017 年链接的英国癌症登记处和常规医院数据集中确定了年龄在 50 岁及以上、单侧诊断为 1-3A 期早期浸润性乳腺癌的女性。采用逻辑回归分析评估肿瘤和患者因素对手术的影响。
在 83188 名女性中，86.8%的患者患有 ER 阳性早期浸润性乳腺癌，13.2%的患者患有 ER 阴性早期浸润性乳腺癌。这些比例不受诊断时年龄的影响。与 ER 阴性乳腺癌患者相比，ER 阳性乳腺癌患者具有更多低危肿瘤特征：G1（20.0%比 1.5%）、T1（60.8%比 44.2%）和 N0（73.9%比 68.8%）。患有任何记录并存疾病（13.7%比 14.3%）或虚弱程度（25%比 25.8%）的女性比例在 ER 阳性和 ER 阴性疾病患者中相似。在年龄为 70-74 岁、75-79 岁和 80 岁及以上的 ER 阳性早期浸润性乳腺癌女性中，未行手术的比例分别为 5.6%、11.0%和 41.9%。在 ER 阴性早期浸润性乳腺癌女性中，相应的比例分别为 3.8%、3.7%和 12.3%。ER 阳性乳腺癌患者手术率较低的情况在健康状况良好的患者中仍然存在。
应该进一步探讨观察差异的原因，以确保治疗决策的一致性。
