Peng Yuan, Hu Taobo, Cheng Lin, Tong Fuzhong, Cao Yingming, Liu Peng, Zhou Bo, Liu Miao, Liu Hongjun, Guo Jiajia, Xie Fei, Yang Houpu, Wang Siyuan, Wang Chaobin, Wang Shu
Breast Center, Peking University People's Hospital, Beijing, China.
Front Oncol. 2021 Mar 12;11:578880. doi: 10.3389/fonc.2021.578880. eCollection 2021.
The dilemma of undertreatment and overtreatment of elderly breast cancer patients is common. This study aimed to investigate clinicopathological features, treatment modalities, and survival in women diagnosed with breast cancer at age 70 years or over, and to assist clinicians in developing individualized treatment plans by balancing the risks of breast cancer-specific death (BCSD) and other cause-specific death (OCSD). This retrospective study included 420 women who were diagnosed with pathologically confirmed invasive breast cancer at age 70 years or older from January 2008 to December 2015 at Peking University People's Hospital (PKUPH). We collected baseline health status, tumor characteristics, treatment choices, and outcomes and created nomograms for clinicians to estimate individualized BCSD and OCSD risk directly. During a median follow-up of 71.5 months (range 2 to 144 months) in patients with stage I-III tumors, breast cancer specific survival (BCSS) was 92.4% (376/407) and overall survival (OS) was 78.1% (318/407). There were 89 deaths, and 65.2% (58/89) were non-breast cancer related. Upon multivariate analysis by Cox regression model, tumor size, positive lymph nodes, Ki-67, and surgery were independent predictors of BCSS, and comorbidities, positive lymph nodes, Ki-67, surgery, and endocrine therapy were independent predictors of OS. Propensity score weighted (PSW) was applied to analyze therapeutic efficacy, and there was BCSS and OS benefit with surgery (both < 0.001), BCSS benefit with chemotherapy ( = 0.029), BCSS and OS benefit with endocrine therapy ( = 0.006 and 0.004), and neither BCSS nor OS benefit with radiotherapy (RT) ( = 0.348 and 0.289). Competing-risk nomograms were developed to estimate cumulative mortality probabilities for BCSD and OCSD for individual patients according to clinicopathologic characteristics and treatments. The calibration curves displayed exceptionally, with C-indexes 0.714 for BCSD and 0.717 for OCSD. Older patients had greater risk of dying from non-breast cancer causes. Surgery, chemotherapy, and endocrine therapy were associated with improved survival. Competing risk nomograms allowed individual assessment of BCSD and OCSD, based on clinicopathological characteristics and treatment options, and can be used as a tool to help in choosing appropriate treatment strategies. This study was approved by the Peking University People's Hospital Research Ethics Board on September 4, 2018.
老年乳腺癌患者治疗不足和过度治疗的困境很常见。本研究旨在调查70岁及以上确诊为乳腺癌的女性的临床病理特征、治疗方式和生存情况，并通过平衡乳腺癌特异性死亡（BCSD）和其他特定原因死亡（OCSD）的风险，协助临床医生制定个体化治疗方案。这项回顾性研究纳入了420名2008年1月至2015年12月在北京大学人民医院（PKUPH）确诊为病理证实的浸润性乳腺癌且年龄在70岁及以上的女性。我们收集了基线健康状况、肿瘤特征、治疗选择和结局，并创建了列线图，供临床医生直接估计个体化的BCSD和OCSD风险。在I - III期肿瘤患者的中位随访71.5个月（范围2至144个月）期间，乳腺癌特异性生存（BCSS）为92.4%（376/407），总生存（OS）为78.1%（318/407）。共有89例死亡，其中65.2%（58/89）与非乳腺癌相关。通过Cox回归模型进行多因素分析，肿瘤大小、阳性淋巴结、Ki-67和手术是BCSS的独立预测因素，合并症、阳性淋巴结、Ki-67、手术和内分泌治疗是OS的独立预测因素。应用倾向评分加权（PSW）分析治疗效果，手术对BCSS和OS均有益（均<0.001），化疗对BCSS有益（=0.029），内分泌治疗对BCSS和OS均有益（=0.006和0.004），放疗（RT）对BCSS和OS均无益处（=0.348和0.289）。开发了竞争风险列线图，根据临床病理特征和治疗方法估计个体患者BCSD和OCSD的累积死亡概率。校准曲线显示良好，BCSD的C指数为0.714，OCSD的C指数为0.717。老年患者死于非乳腺癌原因的风险更高。手术、化疗和内分泌治疗与生存改善相关。竞争风险列线图可根据临床病理特征和治疗选择对BCSD和OCSD进行个体评估，并可作为帮助选择合适治疗策略的工具。本研究于2018年9月4日获得北京大学人民医院研究伦理委员会批准。
