Zhang Xu, Zeng Yufei, Wang Zheng, Chen Xiaosong, Shen Kunwei
Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Front Surg. 2023 May 5;10:1074980. doi: 10.3389/fsurg.2023.1074980. eCollection 2023.
Local treatment for ductal carcinoma (DCIS) remains controversial for elderly patients. This study aims to evaluate the association of local treatment, clinicopathological factors, and survival in elderly DCIS patients.
Patients ≥ 60 years diagnosed with DCIS from January 2009 to December 2018 were retrospectively included. Local treatment including breast surgery, axillary lymph node (ALN) surgery, and radiotherapy were analyzed among subgroups (age of 60-69, 70-79, and ≥ 80 years), and their associations with clinicopathological features and prognostic outcome were further evaluated.
A total of 331 patients were included. Eventually 86 patients received breast conserving surgery (BCS) and 245 patients received mastectomy. ALN surgery was omitted in 62 patients. Age and tumor size were independent factors that influenced the breast and ALN surgery (< 0.05). Compared with patients aging 60-69, patients ≥ 80 years were more likely to receive BCS (OR 4.28, 95% CI 1.33-13.78, = 0.015) and be exempt from ALN surgery (OR 0.19, 95% CI 0.05-0.69, = 0.011). Patients with tumor >1.5 cm were significantly less likely to receive BCS (OR 0.45, 95%CI 0.25-0.83, = 0.011) and more likely to receive ALN surgery (OR 4.41, 95%CI 1.96-10.48, = 0.001) compared to patients with tumor ≤ 1.5 cm. Postoperative radiotherapy was performed in 48.8% patients who received BCS. Age was the only factor that associated with the radiotherapy decision after BCS in elderly DCIS patients (= 0.025). No significant recurrence-free survival difference was observed among patients receiving different local treatments.
Age was related to the choice of local treatment in elderly DCIS patients, but different treatment patterns didn't impact disease outcome.
老年导管原位癌（DCIS）患者的局部治疗仍存在争议。本研究旨在评估老年DCIS患者局部治疗、临床病理因素与生存之间的关联。
回顾性纳入2009年1月至2018年12月期间诊断为DCIS的≥60岁患者。在亚组（60 - 69岁、70 - 79岁和≥80岁）中分析包括乳房手术、腋窝淋巴结（ALN）手术和放疗在内的局部治疗，并进一步评估它们与临床病理特征和预后结果的关联。
共纳入331例患者。最终，86例患者接受了保乳手术（BCS），245例患者接受了乳房切除术。62例患者未进行ALN手术。年龄和肿瘤大小是影响乳房和ALN手术的独立因素（<0.05）。与60 - 69岁的患者相比，≥80岁的患者更有可能接受BCS（OR 4.28，95%CI 1.33 - 13.78，=0.015）且无需进行ALN手术（OR 0.19，95%CI 0.05 - 0.69，=0.011）。与肿瘤≤1.5 cm的患者相比，肿瘤>1.5 cm的患者接受BCS的可能性显著降低（OR 0.45，95%CI 0.25 - 0.83，=0.011），接受ALN手术的可能性更高（OR 4.41，95%CI 1.96 - 10.48，=0.001）。接受BCS的患者中有48.8%进行了术后放疗。年龄是老年DCIS患者BCS后放疗决策的唯一相关因素（=0.025）。接受不同局部治疗的患者之间未观察到无复发生存差异。
年龄与老年DCIS患者的局部治疗选择有关，但不同的治疗模式不影响疾病结局。
