USF Health Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
Department of Surgical Oncology, Moffitt Cancer Center, 12902 N. McKinley Drive, Tampa, FL, 33612, USA.
Breast Cancer Res Treat. 2022 Dec;196(3):441-451. doi: 10.1007/s10549-022-06751-9. Epub 2022 Oct 8.
Neoadjuvant systemic therapy (NAST) can be an effective treatment option for patients with HER2 + or triple negative breast cancer (TNBC). However, its use in geriatric patients is largely understudied. Our aim is to investigate the effect of NAST in both septuagenarians and octogenarians with HER2 + or TNBC to better understand its role in the geriatric patient population.
We utilized the National Cancer Database (NCDB) to analyze female patients with HER2 + or TNBC between 70 and 89 years. We compared the baseline demographic and clinical characteristics of septuagenarians and octogenarians using mixed-effect modeling for continuous variables and conditional logistic regressions for categorical variables. Overall survival (OS) between several subgroups was compared based on a propensity score model. Kaplan-Meier method was used to calculate OS between the subgroups, and log-rank test was used to compare OS results.
A total of 16,443 patients met inclusion/exclusion criteria, of which 92.9% had infiltrative ductal carcinoma and 73.5% were TNBC. Most patients received NAST as a first course of therapy (58.8%). Septuagenarians were more likely to receive NAST (65.9%), whereas octogenarians were more likely to receive upfront surgical resection (67.7%). Our analysis demonstrated OS benefit with NAST among patients who received surgical resection. However, in patients who received NAST, decline during therapy was associated with a significantly poorer OS outcomes in general.
When combined with surgical resection, NAST is an effective treatment option in both septuagenarians and octogenarians. Nonetheless, careful selection of NAST recipients in this population remains critical to optimize patient outcome.
新辅助全身治疗（NAST）可以是 HER2+或三阴性乳腺癌（TNBC）患者的有效治疗选择。然而，其在老年患者中的应用研究甚少。我们的目的是研究 NAST 在 70 至 89 岁的 HER2+或 TNBC 老年患者中的作用，以更好地了解其在老年患者人群中的作用。
我们利用国家癌症数据库（NCDB）分析了 70 至 89 岁的 HER2+或 TNBC 女性患者。我们使用混合效应模型比较了 70 至 79 岁和 80 至 89 岁两组患者的基线人口统计学和临床特征，采用条件逻辑回归分析分类变量。根据倾向评分模型比较了几个亚组之间的总生存（OS）。Kaplan-Meier 法用于计算亚组之间的 OS，对数秩检验用于比较 OS 结果。
共有 16443 例患者符合纳入/排除标准，其中 92.9%为浸润性导管癌，73.5%为 TNBC。大多数患者接受 NAST 作为一线治疗（58.8%）。70 至 79 岁组更有可能接受 NAST（65.9%），而 80 至 89 岁组更有可能接受 upfront 手术切除（67.7%）。我们的分析表明，接受手术切除的患者接受 NAST 治疗有生存获益。然而，在接受 NAST 治疗的患者中，一般来说，治疗期间病情恶化与较差的 OS 结果显著相关。
当与手术切除联合使用时，NAST 是 70 至 79 岁和 80 至 89 岁老年患者的有效治疗选择。然而，在该人群中选择 NAST 接受者仍然至关重要，以优化患者的治疗效果。
