老年（≥70 岁）可手术原发性三阴性乳腺癌的预后因素和模型：来自国家癌症数据库的分析。

BACKGROUND: Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer. In the elderly (≥70 years old) primary operable (TNM) TNBC, individualized treatment modalities for this population are pivotal and important, but limited studies are explored. METHODS: The clinicopathological features of elderly primary operable TNBC patients were retrospectively selected from the Surveillance, Epidemiology, and End Results (SEER) database between January 2010 and December 2015. Kaplan-Meier curves were used to show the survival patterns in the different subgroups. Multivariate Cox analysis was used to identify independent risk factors in the 3-, 5-, and 7- year overall survival (OS) and cancer-specific survival (CSS) in this subpopulation. The predictive model was further developed and validated for clinical use. RESULT: Between 2010 and 2015 years, a total of 4,761 elderly primary operable TNBC patients were enrolled for the study, with a mean age of 76 years and a median follow-up of 56 months. The multivariate Cox analysis showed that age (increased per year: hazard ratio (HR) = 1.05), race (Asian/Pacific Islander and American Indian/Alaska Native, HR = 0.73), differentiation grade (grade II: HR = 2.01; grade III/IV: HR = 2.67), larger tumor size (T: HR = 1.83; T: HR = 2.78; T: HR = 4.93), positive N stage (N: HR = 1.60; N: HR = 1.54), receiving radiation therapy (HR = 0.66), and receiving adjuvant chemotherapy (HR = 0.61) were the independent prognostic factors for OS, and a similar prognostic pattern was also determined in CSS. Besides, two nomograms for predicting the 3-, 5-, and 7-year OS and CSS in this population were developed with a favorable concordance index of 0.716 and 0.746, respectively. CONCLUSION: The results highlight that both radiation and adjuvant chemotherapy are significantly associated with favorable long-term OS and CSS probability in elderly primary operable TNBC patients. Based on the determined independent prognostic factors, the novel nomograms could assist the oncologists to make individualized clinical decisions for the subpopulation at different risks.

背景：三阴性乳腺癌（TNBC）是一种侵袭性乳腺癌亚型。在老年（≥70 岁）可手术（TNM）原发性 TNBC 患者中，为该人群制定个体化治疗方案至关重要，但目前探索有限。

方法：从 2010 年 1 月至 2015 年 12 月，从监测、流行病学和最终结果（SEER）数据库中回顾性选择老年原发性可手术 TNBC 患者的临床病理特征。Kaplan-Meier 曲线用于显示不同亚组的生存模式。多变量 Cox 分析用于确定该亚群中 3 年、5 年和 7 年总生存（OS）和癌症特异性生存（CSS）的独立风险因素。进一步开发并验证预测模型以用于临床。

结果：在 2010 年至 2015 年期间，共有 4761 名老年原发性可手术 TNBC 患者入组本研究，平均年龄为 76 岁，中位随访时间为 56 个月。多变量 Cox 分析显示，年龄（每年增加：风险比（HR）=1.05）、种族（亚裔/太平洋岛民和美洲印第安人/阿拉斯加原住民，HR=0.73）、分化程度（等级 II：HR=2.01；等级 III/IV：HR=2.67）、肿瘤较大（T：HR=1.83；T：HR=2.78；T：HR=4.93）、阳性 N 期（N：HR=1.60；N：HR=1.54）、接受放疗（HR=0.66）和接受辅助化疗（HR=0.61）是 OS 的独立预后因素，CSS 也呈现出相似的预后模式。此外，还开发了两个用于预测该人群 3 年、5 年和 7 年 OS 和 CSS 的列线图，具有良好的一致性指数分别为 0.716 和 0.746。

结论：结果强调，放疗和辅助化疗均与老年原发性可手术 TNBC 患者的长期 OS 和 CSS 概率显著相关。基于确定的独立预后因素，新的列线图可以帮助肿瘤学家为不同风险的亚群做出个体化的临床决策。