Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK.
Brighton and Sussex Medical School, Brighton, UK.
Br J Surg. 2021 Apr 5;108(3):315-325. doi: 10.1093/bjs/znaa125.
Primary endocrine therapy may be an alternative treatment for less fit women with oestrogen receptor (ER)-positive breast cancer. This study compared quality-of-life (QoL) outcomes in older women treated with surgery or primary endocrine therapy.
This was a multicentre, prospective, observational cohort study of surgery or primary endocrine therapy in women aged over 70 years with operable breast cancer. QoL was assessed using European Organisation for Research and Treatment of cancer QoL questionnaires QLQ-C30, -BR23, and -ELD14, and the EuroQol Five Dimensions 5L score at baseline, 6 weeks, and 6, 12, 18, and 24 months. Propensity score matching was used to adjust for baseline variation in health, fitness, and tumour stage.
The study recruited 3416 women (median age 77 (range 69-102) years) from 56 breast units. Of these, 2979 (87.2 per cent) had ER-positive breast cancer; 2354 women had surgery and 500 received primary endocrine therapy (125 were excluded from analysis due to inadequate data or non-standard therapy). Median follow-up was 52 months. The primary endocrine therapy group was older and less fit. Baseline QoL differed between the groups; the mean(s.d.) QLQ-C30 global health status score was 66.2(21.1) in patients who received primary endocrine therapy versus 77.1(17.8) among those who had surgery plus endocrine therapy. In the unmatched analysis, changes in QoL between 6 weeks and baseline were noted in several domains, but by 24 months most scores had returned to baseline levels. In the matched analysis, major surgery (mastectomy or axillary clearance) had a more pronounced adverse impact than primary endocrine therapy in several domains.
Adverse effects on QoL are seen in the first few months after surgery, but by 24 months these have largely resolved. Women considering surgery should be informed of these effects.
初级内分泌治疗可能是雌激素受体（ER）阳性乳腺癌身体状况较差的女性的替代治疗方法。本研究比较了接受手术或初级内分泌治疗的老年女性的生活质量（QoL）结局。
这是一项针对 70 岁以上可手术乳腺癌女性的多中心、前瞻性、观察性队列研究，比较手术或初级内分泌治疗。使用欧洲癌症研究与治疗组织生活质量问卷 QLQ-C30、-BR23 和 -ELD14，以及 EuroQol 五维 5L 评分，在基线、6 周以及 6、12、18 和 24 个月时评估 QoL。采用倾向评分匹配来调整健康、体能和肿瘤分期的基线差异。
该研究从 56 个乳腺单位共招募了 3416 名女性（中位年龄 77（范围 69-102）岁）。其中，2979 名（87.2%）患有 ER 阳性乳腺癌；2354 名女性接受了手术，500 名接受了初级内分泌治疗（由于数据不足或非标准治疗，有 125 名被排除在分析之外）。中位随访时间为 52 个月。初级内分泌治疗组年龄较大，体能较差。两组基线 QoL 存在差异；接受初级内分泌治疗的患者的 QLQ-C30 全球健康状况评分的平均值（标准差）为 66.2（21.1），而接受手术加内分泌治疗的患者为 77.1（17.8）。在未匹配分析中，在 6 周和基线之间，几个领域的 QoL 发生了变化，但在 24 个月时，大多数评分已恢复到基线水平。在匹配分析中，与初级内分泌治疗相比，主要手术（乳房切除术或腋窝清扫术）在多个领域具有更明显的不良影响。
手术后的前几个月会出现 QoL 的不良影响，但到 24 个月时，这些影响已基本消除。考虑手术的女性应了解这些影响。
