新辅助化疗治疗老年乳腺癌：我们是否实现了治疗目标？
Neoadjuvant Chemotherapy for Breast Cancer In the Elderly: Are We Accomplishing Our Treatment Goals?
机构信息
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Breast Cancer Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
出版信息
Ann Surg Oncol. 2022 Dec;29(13):8002-8011. doi: 10.1245/s10434-022-12206-8. Epub 2022 Jul 24.
INTRODUCTION
Rates of downstaging and tolerability to NAC in women age ≥ 70 years with operable breast cancer have not been well studied. We sought to compare downstaging rates and NAC completion between women age 50-69 years and age ≥ 70 years.
METHODS
Consecutively treated women age ≥ 50 years with cT1-3N0-1 breast cancer receiving NAC followed by surgery from November 2013 to April 2020 were studied. Rates of downstaging from breast-conserving surgery (BCS)-ineligible to BCS-eligible and avoidance of axillary dissection (ALND) in cN1 patients were compared between patients age 50-69 and ≥ 70 years. NAC regimens and rates of completion also were assessed.
RESULTS
Overall, 651 women, age ≥ 50 years, with 668 cT1-3N0-1 breast cancers that were treated with NAC, were identified; 75 (11.1%) were age ≥ 70 years. Patients age ≥ 70 years were less likely to have lobular cancers (5% vs. 10%, p = 0.03), receive an anthracycline-based regimen (69% vs. 93%, p < 0.001), and complete their entire prescribed regimen (57% vs. 78%, p < 0.001). Of 312 BCS-ineligible patients eligible for downstaging, conversion rates to BCS-eligibility were similar between age groups (72% [≥ 70] vs. 74% [50-69], p > 0.9). Women age ≥ 70 years who converted to BCS-eligible post-NAC were more likely to undergo BCS than younger patients (93% vs. 74%, p = 0.04). Of 390 cN1 patients, 162 (42%) achieved a nodal pCR; ALND avoidance was similar between age groups (43% [≥ 70] vs. 42% [50-69], p > 0.9).
CONCLUSIONS
While patients age ≥ 70 years received less anthracycline-based NAC and were less likely to complete their prescribed regimen, they experienced high rates of breast and axillary downstaging, similar to younger patients, suggesting that well-selected elderly patients can safely receive NAC with substantial clinical benefit.
简介
年龄≥70 岁可手术乳腺癌患者新辅助化疗（NAC）降期率和耐受性的相关研究较少。本研究旨在比较年龄 50-69 岁和≥70 岁女性的降期率和 NAC 完成率。
方法
回顾性分析 2013 年 11 月至 2020 年 4 月期间，年龄≥50 岁、接受 NAC 治疗后行手术的 cT1-3N0-1 乳腺癌患者。比较 50-69 岁和≥70 岁患者中保乳手术（BCS）不合格转化为 BCS 合格和 cN1 患者避免腋窝清扫（ALND）的降期率。还评估了 NAC 方案和完成率。
结果
共纳入 651 例年龄≥50 岁、668 例 cT1-3N0-1 乳腺癌患者，其中 75 例（11.1%）年龄≥70 岁。≥70 岁患者的小叶癌比例较低（5% vs. 10%，p=0.03），接受蒽环类药物为基础的方案治疗的比例较低（69% vs. 93%，p<0.001），且完成完整规定方案的比例较低（57% vs. 78%，p<0.001）。在 312 例 BCS 不合格但有降期可能的患者中，两组的转化为 BCS 合格的转化率相似（≥70 岁组：72% vs. 50-69 岁组：74%，p>0.9）。≥70 岁且经 NAC 转化为 BCS 合格的患者接受 BCS 的比例高于年轻患者（93% vs. 74%，p=0.04）。在 390 例 cN1 患者中，162 例（42%）达到淋巴结病理完全缓解（pCR）；两组的 ALND 避免率相似（≥70 岁组：43% vs. 50-69 岁组：42%，p>0.9）。
结论
虽然≥70 岁患者接受蒽环类药物为基础的 NAC 治疗较少，且完成规定方案的比例较低，但他们的乳房和腋窝降期率较高，与年轻患者相似，这表明精心选择的老年患者可以安全地接受 NAC，获得显著的临床获益。
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