Department of Surgery, Duke University Medical Center (DUMC), Durham, NC, USA.
Duke Cancer Institute, Duke University, Durham, NC, USA.
Ann Surg Oncol. 2023 Oct;30(10):6141-6150. doi: 10.1245/s10434-023-13880-y. Epub 2023 Jul 19.
Benefits of a pathologic complete response (pCR) following neoadjuvant therapy are well established, yet outcomes for older women are understudied. We sought to examine the pCR and overall survival (OS) rates of women with estrogen receptor (ER) positive breast cancer across age groups.
Women diagnosed with cT1-4, N0-3, M0, ER+/HER2- breast cancer (2010-2018) who underwent neoadjuvant chemotherapy (NACT) or neoadjuvant endocrine therapy (NET) followed by surgery were selected from the National Cancer Database and categorized by age. Differences were tested, and Cox proportional hazards models were used to estimate the association of response with OS after adjustment for covariates.
In the 43,009-patient cohort, 84.8% received NACT and 15.2% received NET. Of those aged ≥ 70 (N = 5623), 51.0% received NACT, and 49.0% received NET. Compared with younger women receiving NACT, older women were less likely to have a breast or nodal pCR [no pCR by age: 85.1% (≥ 70 years) vs 82.2% (50-69 years) vs 77.7% (< 50 years), p < 0.001]. Rates of pCR were similarly low for all women receiving NET [no pCR by age: 95.6% (≥ 70 years) vs 95% (50-69 years) vs 96% (< 50 years), p = 0.06]. After adjustment, pCR after NACT was not associated with OS for older patients, but better survival outcomes were noted for older patients achieving pCR after NET.
For women with ER+/HER2- breast cancer, pCR rates after NACT are lower in older women compared with younger women, and are equally low after NET for all women. However, pCR after NET is associated with improved OS among older women, unlike pCR after NACT.
新辅助治疗后病理完全缓解（pCR）的益处已得到充分证实，但针对老年女性的研究结果尚不清楚。我们旨在研究不同年龄组中雌激素受体（ER）阳性乳腺癌患者的 pCR 率和总生存率（OS）。
从国家癌症数据库中选择了 2010 年至 2018 年间诊断为 cT1-4、N0-3、M0、ER+/HER2-乳腺癌（新辅助化疗（NACT）或新辅助内分泌治疗（NET）后手术）的女性，并按年龄分类。通过检验差异，并使用 Cox 比例风险模型估计在调整协变量后，反应与 OS 之间的关联。
在 43009 例患者队列中，84.8%接受了 NACT，15.2%接受了 NET。在≥70 岁的患者中（N=5623），51.0%接受了 NACT，49.0%接受了 NET。与接受 NACT 的年轻女性相比，老年女性的乳房或淋巴结 pCR 可能性较小[无 pCR 按年龄：85.1%（≥70 岁）vs 82.2%（50-69 岁）vs 77.7%（<50 岁），p<0.001]。所有接受 NET 的女性的 pCR 率也同样较低[无 pCR 按年龄：95.6%（≥70 岁）vs 95%（50-69 岁）vs 96%（<50 岁），p=0.06]。调整后，NACT 后 pCR 与老年患者的 OS 无关，但 NET 后达到 pCR 的老年患者的生存结局更好。
对于 ER+/HER2-乳腺癌患者，与年轻女性相比，NACT 后 pCR 率在老年女性中较低，而所有女性接受 NET 后的 pCR 率也较低。然而，与 NACT 后 pCR 不同，NET 后 pCR 与老年女性的 OS 改善相关。
