Han Youming, Sui Zhilin, Jia Yongsheng, Wang Hailong, Dong Yan, Zhang Hongdian, Li Zhigang, Yu Zhentao
Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.
Department of Respiratory medicine, Binhai Hospital of Tianjin Medical University General Hospital, Tianjin, 300456, China.
J Cancer. 2021 Sep 3;12(21):6445-6453. doi: 10.7150/jca.63813. eCollection 2021.
This study aimed to investigate the metastasis patterns and prognosis of breast cancer (BC) in patients aged ≥ 80 years with distant metastases, as the current literature lacks studies in this population. A retrospective, population-based study using data from the Surveillance, Epidemiology, and End Results (SEER) database was conducted to evaluate 36,203 patients with BC from 2010 to 2016. Patients were classified into three groups, the older group (aged ≥ 80 years), middle-aged group (aged 60-79 years), and younger group (aged < 60 years). The role of age at the time of BC diagnosis in metastasis patterns was investigated, and the survival of different age groups of patients with BC was assessed. Overall, 4,359 (12%) patients were diagnosed with BC at age ≥ 80 years, 19,688 (54%) at 60-79 years, and 12,156 (34%) at < 60 years. Compared with the other two groups, those in the older group had a lower rate of treatment acceptance. Statistical analysis revealed that older patients were more likely to have lung invasion only (odds ratio [OR]: 1.274, 95% confidence interval [CI]: 1.163-2.674) and less likely to have bone invasion only (OR: 0.704, 95% CI: 0.583-0.851), brain invasion only (OR: 0.329, 95% CI: 0.153-0.706), or multiple metastatic sites (OR: 0.361, 95% CI: 0.284-0.458) compared to the other two groups. Age at diagnosis was an independent prognostic factor for survival. The older group had the worst overall survival (OS, P<0.001) and BC-specific survival (CSS, P<0.001). Furthermore, patients aged ≥ 80 years with only liver metastasis had the worst CSS and OS. Patients aged ≥ 80 years were less likely to be receptive to cancer-related therapy and had the highest cancer mortality rate among all patients. Our findings will hopefully help clinicians develop more appropriate modalities of cancer treatment in elderly BC patients.
本研究旨在调查年龄≥80岁且有远处转移的乳腺癌（BC）患者的转移模式和预后，因为目前文献中缺乏针对该人群的研究。我们进行了一项基于人群的回顾性研究，使用监测、流行病学和最终结果（SEER）数据库中的数据，评估了2010年至2016年期间的36203例BC患者。患者被分为三组，老年组（年龄≥80岁）、中年组（年龄60 - 79岁）和青年组（年龄<60岁）。研究了BC诊断时年龄在转移模式中的作用，并评估了不同年龄组BC患者的生存率。总体而言，4359例（12%）患者在年龄≥80岁时被诊断为BC，19688例（54%）在60 - 79岁时被诊断，12156例（34%）在年龄<60岁时被诊断。与其他两组相比，老年组的治疗接受率较低。统计分析显示，与其他两组相比，老年患者仅发生肺转移的可能性更高（优势比[OR]：1.274，95%置信区间[CI]：1.163 - 2.674），而仅发生骨转移（OR：0.704，95% CI：0.583 - 0.851）、仅发生脑转移（OR：0.329，95% CI：0.153 - 0.706）或有多个转移部位（OR：0.361，95% CI：0.284 - 0.458）的可能性更低。诊断时的年龄是生存的独立预后因素。老年组的总生存期（OS，P<0.001）和BC特异性生存期（CSS，P<0.001）最差。此外，仅发生肝转移的年龄≥80岁患者的CSS和OS最差。年龄≥80岁的患者接受癌症相关治疗的可能性较小，且在所有患者中癌症死亡率最高。我们的研究结果有望帮助临床医生为老年BC患者制定更合适的癌症治疗方案。
