基于国家癌症数据库的分析：辅助内分泌治疗对合并症且雌激素受体阳性、淋巴结阴性的老年乳腺癌患者的影响。
Impact of adjuvant endocrine therapy in older patients with comorbidities and estrogen receptor-positive, node-negative breast cancer-A National Cancer Database analysis.
机构信息
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
出版信息
Cancer. 2021 Jul 1;127(13):2196-2203. doi: 10.1002/cncr.33489. Epub 2021 Mar 18.
BACKGROUND
Data are lacking about the benefit of adjuvant endocrine therapy (ET) in older patients with multiple comorbidities. The authors sought to determine the effect of ET on the survival of older patients who had multiple comorbidities and estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, pathologic node-negative (pN0) breast cancer.
METHODS
Women aged ≥70 years in the National Cancer Database (2010-2014) with Charlson/Deyo comorbidity scores of 2 or 3 who had pathologic tumor (pT1)-pT3/pN0, ER-positive/HER2-negative breast cancer were divided into 2 cohorts: adjuvant ET and no ET. Propensity scores were used to match patients based on age, comorbidity score, facility type, pT classification, chemotherapy, surgery, and radiation therapy. A Cox proportional hazards model was used to estimate the effect of ET on overall survival (OS).
RESULTS
In the nonmatched cohort (n = 3716), 72.8% of patients received ET (n = 2705), and 27.2% did not (n = 1011). The patients who received ET were younger (mean age, 76 vs 79 years; P < .001) and had higher rates of breast conservation compared with those who did not receive ET (lumpectomy plus radiation: 43.4% vs 23.8%, respectively; P < .001). In the matched cohort (n = 1972), the median OS was higher in the ET group (79.2 vs 67.7 months; P < .0001). In the adjusted analysis, ET was associated with improved survival (hazard ratio, 0.70; 95% CI, 0.59-0.83).
CONCLUSIONS
In older patients who have pN0, ER-positive/HER2-negative breast cancer with comorbidities, adjuvant ET was associated with improved OS, which may have been overestimated given the confounders inherent in observational studies. To optimize outcomes in these patients, current standard recommendations should be considered stage-for-stage based on life expectancy and the level of tolerance to treatment.
背景
关于合并多种合并症的老年患者辅助内分泌治疗（ET）的获益，目前数据有限。作者旨在确定 ET 对合并多种合并症且雌激素受体（ER）阳性/人表皮生长因子受体 2（HER2）阴性、病理淋巴结阴性（pN0）乳腺癌的老年患者生存的影响。
方法
国家癌症数据库（2010-2014 年）中年龄≥70 岁、Charlson/Deyo 合并症评分为 2 或 3 分、病理肿瘤（pT）-pT3/pN0、ER 阳性/HER2 阴性乳腺癌的女性被分为 2 个队列：辅助 ET 和无 ET。采用倾向评分匹配患者的年龄、合并症评分、医疗机构类型、pT 分类、化疗、手术和放疗。采用 Cox 比例风险模型估计 ET 对总生存（OS）的影响。
结果
在非匹配队列（n=3716）中，72.8%的患者接受了 ET（n=2705），27.2%的患者未接受 ET（n=1011）。接受 ET 的患者年龄较小（平均年龄 76 岁比 79 岁；P<0.001），且与未接受 ET 的患者相比，保乳率更高（保乳术加放疗：43.4%比 23.8%；P<0.001）。在匹配队列（n=1972）中，ET 组的中位 OS 更高（79.2 比 67.7 个月；P<0.0001）。在调整后的分析中，ET 与生存改善相关（风险比，0.70；95%CI，0.59-0.83）。
结论
在合并多种合并症且 pN0、ER 阳性/HER2 阴性乳腺癌的老年患者中，辅助 ET 与 OS 改善相关，鉴于观察性研究固有的混杂因素，这可能被高估。为了优化这些患者的结局，应根据预期寿命和对治疗的耐受程度，逐期考虑当前的标准推荐。
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