Wadasadawala Tabassum, Patil Roshankumar, Carlton Johnny, Verma Shalini, Umesh Namita, Rane Pallavi, Sarin Rajiv, Pathak Rima, Bajpai Jyoti, Nair Nita, Shet Tanuja, Kaur Ramneet
Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India.
https://orcid.org/0000-0003-2167-420X.
Ecancermedicalscience. 2023 May 2;17:1542. doi: 10.3332/ecancer.2023.1542. eCollection 2023.
Despite advances in treatment, there is rising mortality in elderly patients with breast cancer. We aimed to conduct an audit of non-metastatic elderly breast cancer patients to understand the predictors of outcome.
Data collection was done from electronic medical records. All time-to-event outcomes were analysed using Kaplan-Meier method and compared using log-rank test. Univariate and multi-variate analysis of known prognostic factors was also done. Any p-value ≤0.05 was considered statistically significant.
A total of 385 elderly (>70 years) breast cancer patients (range 70-95 years) were treated at our hospital from January 2013 to December 2016. The hormone receptor was positive in 284 (73.8%) patients; 69 (17.9%) patients had over-expression of HER2-neu, while 70 (18.2%) patients had triple-negative breast cancer. A large majority of women (N = 328, 85.9%) underwent mastectomy while only 54 (14.1%) had breast conservation surgery. Out of 134 patients who received chemotherapy, 111 patients received adjuvant, while the remaining 23 patients received neoadjuvant chemotherapy. Only 15 (21.7%) patients of the 69 HER2-neu receptor-positive patients received adjuvant trastuzumab. Adjuvant radiation was given to 194 (50.3%) women based on the type of surgery and disease stage. Adjuvant hormone therapy was planned using letrozole in 158 (55.6%) patients, while tamoxifen was prescribed in 126 (44.4%). At the median follow up of 71.7 months, the 5-year overall survival, relapse-free survival, locoregional relapse-free survival, distant disease-free survival, breast cancer-specific survival were 75.3%, 74.2%, 84.8%, 76.1% and 84.5%. Age, tumour size, presence of lymphovascular invasion (LVSI) and molecular subtype emerged as independent predictors of survival on multi-variate analysis.
The audit highlights the underutilisation of breast-conserving therapy and systemic therapy in the elderly. Increasing age and tumour size, presence of LVSI and molecular subtype were found to be strong predictors of outcome. The findings from this study will help to improve the current gaps in the management of breast cancer among the elderly.
尽管治疗方法有所进步，但老年乳腺癌患者的死亡率仍在上升。我们旨在对非转移性老年乳腺癌患者进行一项审计，以了解预后的预测因素。
从电子病历中收集数据。所有事件发生时间的结果均采用Kaplan-Meier方法进行分析，并使用对数秩检验进行比较。还对已知的预后因素进行了单变量和多变量分析。任何p值≤0.05均被视为具有统计学意义。
2013年1月至2016年12月期间，我院共治疗了385例老年（>70岁）乳腺癌患者（年龄范围70 - 95岁）。284例（73.8%）患者激素受体呈阳性；69例（17.9%）患者HER2-neu过表达，而70例（18.2%）患者为三阴性乳腺癌。绝大多数女性（N = 328，85.9%）接受了乳房切除术，而只有54例（14.1%）患者接受了保乳手术。在134例接受化疗的患者中，111例接受了辅助化疗，其余23例接受了新辅助化疗。69例HER2-neu受体阳性患者中只有15例（21.7%）接受了辅助曲妥珠单抗治疗。根据手术类型和疾病分期，194例（50.3%）女性接受了辅助放疗。158例（55.6%）患者计划使用来曲唑进行辅助激素治疗，而126例（44.4%）患者开具了他莫昔芬。在中位随访71.7个月时，5年总生存率、无复发生存率、局部区域无复发生存率、远处无病生存率、乳腺癌特异性生存率分别为75.3%、74.2%、84.8%、76.1%和84.5%。年龄、肿瘤大小、淋巴管浸润（LVSI）的存在以及分子亚型在多变量分析中成为生存的独立预测因素。
该审计突出了老年患者保乳治疗和全身治疗的利用不足。年龄增加、肿瘤大小、LVSI的存在以及分子亚型被发现是预后的强有力预测因素。本研究的结果将有助于改善目前老年乳腺癌管理中的差距。
