Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Clin Oncol (R Coll Radiol). 2023 Apr;35(4):e265-e277. doi: 10.1016/j.clon.2023.01.008. Epub 2023 Jan 23.
Clinical trials of post-mastectomy radiotherapy (PMRT) for early invasive breast cancer (EIBC) have included few older women. This study examined whether the association between overall survival or breast cancer-specific survival (BCSS) and receipt of PMRT for EIBC altered with age.
The study used patient-level linked cancer registration, routine hospital and radiotherapy data for England and Wales. It included 31 243 women aged ≥50 years diagnosed between 2014 and 2018 with low- (T1-2N0), intermediate- (T3N0/T1-2N1) or high-risk (T1-2N2/T3N1-2) EIBC who received a mastectomy within 12 months from diagnosis. Patterns of survival were analysed using a landmark approach. Associations between overall survival/BCSS and PMRT in each risk group were analysed with flexible parametric survival models, which included patient and tumour factors; whether the association between PMRT and overall survival/BCSS varied by age was assessed using interaction terms.
Among 4711 women with high-risk EIBC, 86% had PMRT. Five-year overall survival was 70.5% and BCSS was 79.3%. Receipt of PMRT was associated with improved overall survival [adjusted hazard ratio (aHR) 0.75, 95% confidence interval 0.64-0.87] and BCSS (aHR 0.78, 95% confidence interval 0.65-0.95) compared with women who did not have PMRT; associations did not vary by age (overall survival, P-value for interaction term = 0.141; BCSS, P = 0.077). Among 10 814 women with intermediate-risk EIBC, 59% had PMRT; 5-year overall survival was 78.4% and BCSS was 88.0%. No association was found between overall survival (aHR 1.01, 95% confidence interval 0.92-1.11) or BCSS (aHR 1.16, 95% confidence interval 1.01-1.32) and PMRT. There was statistical evidence of a small change in the association with age for overall survival (P = 0.007), although differences in relative survival were minimal, but not for BCSS (P = 0.362).
The association between PMRT and overall survival/BCSS does not appear to be modified by age among women with high- or intermediate-risk EIBC and, thus, treatment recommendations should not be modified on the basis of age alone.
早期浸润性乳腺癌（EIBC）的乳房切除术术后放疗（PMRT）临床试验纳入的老年女性较少。本研究旨在探讨 EIBC 患者接受 PMRT 与总生存或乳腺癌特异性生存（BCSS）之间的关联是否随年龄变化而改变。
该研究使用了英格兰和威尔士的患者级别的癌症登记、常规医院和放疗数据。共纳入 31243 名年龄≥50 岁的女性，这些女性在诊断后 12 个月内接受了保乳手术，诊断为低危（T1-2N0）、中危（T3N0/T1-2N1）或高危（T1-2N2/T3N1-2）EIBC。使用 landmark 方法分析生存模式。使用灵活的参数生存模型分析每个风险组中 PMRT 与总生存/BCSS 之间的关联，该模型包括患者和肿瘤因素；通过交互项评估 PMRT 与总生存/BCSS 之间的关联是否随年龄变化。
在 4711 名高危 EIBC 患者中，86%的患者接受了 PMRT。5 年总生存率为 70.5%，BCSS 为 79.3%。与未接受 PMRT 的患者相比，接受 PMRT 的患者总生存（调整后危险比[aHR]0.75，95%置信区间[CI]0.64-0.87）和 BCSS（aHR 0.78，95%CI 0.65-0.95）均有改善；这种关联不受年龄影响（总生存，交互项 P 值=0.141；BCSS，P=0.077）。在 10814 名中危 EIBC 患者中，59%的患者接受了 PMRT。5 年总生存率为 78.4%，BCSS 为 88.0%。PMRT 与总生存（aHR 1.01，95%CI 0.92-1.11）或 BCSS（aHR 1.16，95%CI 1.01-1.32）之间无关联。虽然相对生存率差异很小，但总生存与年龄的关联有统计学意义上的变化（P=0.007），但 BCSS 则没有（P=0.362）。
在高危或中危 EIBC 女性中，PMRT 与总生存/BCSS 之间的关联似乎不受年龄影响，因此，不应仅根据年龄来修改治疗建议。
