辅助化疗和 HR+/HER2- 乳腺癌老年女性患者的生存结局：基于 SEER 数据库的倾向评分匹配回顾性队列研究。

Adjuvant chemotherapy and survival outcomes in older women with HR+/HER2- breast cancer: a propensity score-matched retrospective cohort study using the SEER database.

机构信息

Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.

Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei, China.

出版信息

BMJ Open. 2024 Mar 15;14(3):e078782. doi: 10.1136/bmjopen-2023-078782.

DOI:10.1136/bmjopen-2023-078782

PMID:38490656

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10946384/

Abstract

OBJECTIVES

This study aimed to investigate the impact of adjuvant chemotherapy (ACT) on survival outcomes in older women with hormone receptor-positive and human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer (BC).

DESIGN

A retrospective cohort study using data from the Surveillance, Epidemiology, and End Results database, which contains publicly available information from US cancer registries.

SETTING AND PARTICIPANTS

The study included 45 762 older patients with BC aged over 65 years diagnosed between 2010 and 2015.

METHODS

Patients were divided into two groups based on age: 65-79 years and ≥80 years. Propensity score matching (PSM) was employed to balance clinicopathological characteristics between patients who received ACT and those who did not. Data analysis used the χ test and Kaplan-Meier method, with a subgroup analysis conducted to identify potential beneficiaries of ACT.

OUTCOME MEASURES

Overall survival (OS) and cancer-specific survival (CSS).

RESULTS

Due to clinicopathological characteristic imbalances between patients with BC aged 65-79 years and those aged ≥80 years, PSM was used to categorise the population into two groups for analysis: the 65-79 years age group (n=38 128) and the ≥80 years age group (n=7634). Among patients aged 65-79 years, Kaplan-Meier analysis post-PSM indicated that ACT was effective in improving OS (p<0.05, HR=0.80, 95% CI 0.73 to 0.88), particularly in those with advanced disease stages, but did not show a significant benefit in CSS (p=0.09, HR=1.13, 95% CI 0.98 to 1.31). Conversely, for patients aged ≥80 years, ACT did not demonstrate any improvement in OS (p=0.79, HR=1.04, 95% CI 0.79 to 1.36) or CSS (p=0.09, HR=1.46, 95% CI 0.69 to 2.26) after matching. Subgroup analysis also revealed no positive impact on OS and CSS.

CONCLUSIONS

Patients with HR+/HER2- BC ≥80 years of age may be considered exempt from ACT because no benefits were found in terms of OS and CSS.

摘要

目的

本研究旨在探讨辅助化疗（ACT）对激素受体阳性和人表皮生长因子受体 2 阴性（HR+/HER2-）乳腺癌（BC）老年女性生存结局的影响。

设计

这是一项回顾性队列研究，使用来自监测、流行病学和最终结果（SEER）数据库的数据，该数据库包含来自美国癌症登记处的公开信息。

地点和参与者

该研究纳入了 2010 年至 2015 年间诊断为年龄超过 65 岁的 45762 名 HR+/HER2-BC 老年患者。

方法

根据年龄将患者分为两组：65-79 岁和≥80 岁。采用倾向评分匹配（PSM）平衡接受 ACT 和未接受 ACT 的患者的临床病理特征。数据分析采用 χ2 检验和 Kaplan-Meier 法，并进行亚组分析以确定 ACT 的潜在获益人群。

结局测量

总生存（OS）和癌症特异性生存（CSS）。

结果

由于 65-79 岁和≥80 岁的 BC 患者之间存在临床病理特征的不平衡，因此使用 PSM 将人群分为两组进行分析：65-79 岁年龄组（n=38128）和≥80 岁年龄组（n=7634）。在 65-79 岁的患者中，PSM 后 Kaplan-Meier 分析表明 ACT 可有效改善 OS（p<0.05，HR=0.80，95%CI 0.73 至 0.88），尤其是在晚期疾病患者中，但在 CSS 方面无显著获益（p=0.09，HR=1.13，95%CI 0.98 至 1.31）。相反，对于≥80 岁的患者，匹配后 ACT 并未改善 OS（p=0.79，HR=1.04，95%CI 0.79 至 1.36）或 CSS（p=0.09，HR=1.46，95%CI 0.69 至 2.26）。亚组分析也未显示对 OS 和 CSS 有积极影响。