Houvenaeghel Gilles, Cohen Monique, Gonçalves Anthony, Berthelot Axel, Chauvet Marie Pierre, Faure Christelle, Classe Jean Marc, Jouve Eva, Sabiani Laura, Bannier Marie, Tassy Louis, Martino Marc, Tallet Agnès, de Nonneville Alexandre
Department of Surgical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France.
Department of Medical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France.
Front Oncol. 2023 Dec 15;13:1287253. doi: 10.3389/fonc.2023.1287253. eCollection 2023.
BACKGROUND: Elderly breast cancer (BC) patients have been underrepresented in clinical trials whereas ~60% of deaths from BC occur in women aged 70 years and older. Only limited data are available on the prognostic impact of age according to treatment, especially in the triple-negative (TN) and Her2-positive because of the lower frequency of these subtypes in elderly patients. We report herein the results of a multicenter retrospective study analyzing the prognostic impact of age according to treatment delivered in TN and Her2-positive BC patients of 70 years or older, including comparison by age groups. METHODS: The medical records of 31,473 patients treated from January 1991 to December 2018 were retrieved from 13 French cancer centers for retrospective analysis. Our study population included all ≥70 patients with TN or Her2-positive BC treated by upfront surgery. Three age categories were determined: 70-74, 75-80, and > 80 years. RESULTS: Of 528 patients included, 243 patients were 70-74 years old (46%), 172 were 75-80 years (32.6%) and 113 were >80 years (21.4%). Half the population (51.9%, 274 patients) were TN, 30.1% (159) Her2-positive/hormone receptors (HR)-positive, and, 18% (95) Her2-positive/endocrine receptors (ER)-negative BC. Advanced tumor stage was associated with older age but no other prognostic factors (tumor subtype, tumor grade, LVI). Adjuvant chemotherapy delivery was inversely proportional to age. With 49 months median follow-up, all patient outcomes (overall survival (OS), disease-free survival (DFS), breast cancer-specific survival (BCSS), and recurrence-free survival (RFS)) significantly decreased as age increased. In multivariate analysis, age >80, pT2-3 sizes, axillary macrometastases, lymphovascular involvement, and HR-negativity tumor negatively affected DFS and OS. Comparison between age >80 and <=80 years old showed worse RFS in patients aged > 80 (HR=1.771, p=0.031). CONCLUSION: TN and Her2-positive subtypes occur at similar frequency in elderly patients. Older age is associated with more advanced tumor stage presentation. Chemotherapy use decreases with older age without worse other pejorative prognostic factors. Age >80, but not ≤80, independently affected DFS and OS.
背景：老年乳腺癌（BC）患者在临床试验中的代表性不足，而约60%的BC死亡发生在70岁及以上的女性中。关于年龄根据治疗方式的预后影响的可用数据有限，特别是在三阴性（TN）和人表皮生长因子受体2阳性（Her2阳性）患者中，因为这些亚型在老年患者中出现的频率较低。我们在此报告一项多中心回顾性研究的结果，该研究分析了年龄对70岁及以上TN和Her2阳性BC患者接受的治疗方式的预后影响，包括按年龄组进行比较。 方法：从13个法国癌症中心检索了1991年1月至2018年12月期间接受治疗的31473例患者的病历进行回顾性分析。我们的研究人群包括所有接受 upfront手术治疗的年龄≥70岁的TN或Her2阳性BC患者。确定了三个年龄类别：70 - 74岁、75 - 80岁和>80岁。 结果：在纳入的528例患者中，243例患者年龄在70 - 74岁（46%），172例年龄在75 - 80岁（32.6%），113例年龄>80岁（21.4%）。一半的人群（51.9%，274例患者）为TN型，30.1%（159例）为Her2阳性/激素受体（HR）阳性，18%（95例）为Her2阳性/内分泌受体（ER）阴性BC。肿瘤晚期与年龄较大相关，但没有其他预后因素（肿瘤亚型、肿瘤分级、淋巴管浸润）。辅助化疗的使用与年龄成反比。中位随访49个月，所有患者的结局（总生存期（OS）、无病生存期（DFS）、乳腺癌特异性生存期（BCSS）和无复发生存期（RFS））随着年龄的增加而显著降低。在多变量分析中，年龄>80岁、pT2 - 3大小、腋窝大转移、淋巴管浸润和HR阴性肿瘤对DFS和OS有负面影响。年龄>80岁和≤80岁的患者比较显示，年龄>80岁的患者RFS更差（风险比（HR）=1.771，p = 0.031）。 结论：TN和Her2阳性亚型在老年患者中出现的频率相似。年龄较大与更晚期的肿瘤分期相关。化疗的使用随着年龄的增加而减少，且没有更差的其他不良预后因素。年龄>80岁，但不是≤80岁，独立影响DFS和OS。
Breast Cancer Res Treat. 2021-8
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