Pu Shengyu, Xie Peiling, Chen Heyan, Li Yijun, He Jianjun, Zhang Huimin
Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan'xi, China.
Front Oncol. 2023 Mar 28;13:992573. doi: 10.3389/fonc.2023.992573. eCollection 2023.
With the aging of the population, the number of elderly breast cancer cases has increased. However, there is a lack of effective randomized clinical trial data to support whether elderly patients should receive chemotherapy. Our goal was to observe the relationship between chemotherapy and breast cancer-specific survival (BCSS) in elderly breast cancer patients and to identify those who could benefit from chemotherapy.
We collected the data of patients who were diagnosed with invasive ductal carcinoma and older than 70 years in the SEER database from 1995 to 2016. The independent predictors of BCSS were identified by Cox regression analysis. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were performed to eliminate confounding factors.
A total of 142,537 patients were collected, including 21,782 patients in the chemotherapy group and 120,755 patients in the non-chemotherapy group. We identified the same potential predictors of BCSS after PSM and IPTW, such as age, race, grade, stage, therapy, subtype. A nomogram for predicting 3-year, 5-year and 10-year BCSS was constructed. The 3-year, 5-year and 10-year AUCs of the nomogram were 0.842, 0.819, and 0.788. According to the risk stratification of model predictive scores, patients in the high-risk group achieved the greatest improvement in BCSS after receiving chemotherapy.
Our study suggests that women older than 70 years with larger tumors, higher grade, positive nodes, negative hormone receptor and inactive local therapy gain prognostic benefits from chemotherapy, but for those with low- and median-risk, conventional chemotherapy should be administered cautiously.
随着人口老龄化，老年乳腺癌病例数量有所增加。然而，缺乏有效的随机临床试验数据来支持老年患者是否应接受化疗。我们的目标是观察化疗与老年乳腺癌患者的乳腺癌特异性生存（BCSS）之间的关系，并确定哪些患者能从化疗中获益。
我们收集了1995年至2016年监测、流行病学与最终结果（SEER）数据库中诊断为浸润性导管癌且年龄大于70岁的患者数据。通过Cox回归分析确定BCSS的独立预测因素。进行倾向评分匹配（PSM）和逆概率处理加权（IPTW）以消除混杂因素。
共收集了142,537例患者，其中化疗组21,782例，非化疗组120,755例。PSM和IPTW后，我们确定了相同的BCSS潜在预测因素，如年龄、种族、分级、分期、治疗方式、亚型。构建了预测3年、5年和10年BCSS的列线图。列线图的3年、5年和10年曲线下面积（AUC）分别为0.842、0.819和0.788。根据模型预测评分的风险分层，高危组患者接受化疗后BCSS改善最大。
我们的研究表明，年龄大于70岁、肿瘤较大、分级较高、淋巴结阳性、激素受体阴性且局部治疗不积极的女性从化疗中获得预后益处，但对于低风险和中风险患者，应谨慎给予传统化疗。
