Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
Ann Surg Oncol. 2024 Oct;31(10):6812-6819. doi: 10.1245/s10434-024-15894-6. Epub 2024 Jul 20.
As the benefits of intensive locoregional therapy for ductal carcinoma in situ (DCIS) are realized over time in older adults, life expectancy may help to guide treatment decisions. We examined whether life expectancy was associated with extent of locoregional therapy in this population.
Women ≥ 70 years old with < 5 cm of DCIS diagnosed 2010-2015 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset and categorized by a life expectancy ≤ 5 or > 5 years, defined by a validated claims-based measure. Differences in locoregional therapy (mastectomy + axillary surgery, mastectomy-only, lumpectomy + radiation therapy (RT) + axillary surgery, lumpectomy + RT, lumpectomy-only, and no treatment) by life expectancy were assessed using Pearson chi-squared tests. Generalized linear mixed models were used to identify factors associated with receipt of lumpectomy-only.
Of 5346 women (median age of 75 years, range 70-97 years), 927 (17.3%) had a life expectancy ≤ 5 years. Of the 4041 patients who underwent lumpectomy, 710 (13.3%) underwent axillary surgery. More patients with life expectancy ≤ 5 years underwent lumpectomy-only (39.4% versus 27%), mastectomy-only (8.1% versus 5.3%), or no treatment (5.8% versus 3.2%; p < 0.001). On multivariable analysis, women with life expectancy ≤ 5 years had a significantly greater likelihood of undergoing lumpectomy-only [OR 1.90, 95% CI (1.63-2.22)].
Life expectancy is associated with lower-intensity locoregional therapy for older women with DCIS, yet a large proportion of patients with a life expectancy ≤ 5 years received RT and axillary surgery, highlighting potential overtreatment and opportunities to de-escalate locoregional therapy in older adults.
随着强化局部区域治疗对导管原位癌（DCIS）的益处随着时间的推移在老年人中逐渐显现，预期寿命可能有助于指导治疗决策。我们研究了在这一人群中，预期寿命是否与局部区域治疗的范围有关。
在监测、流行病学和最终结果（SEER）-医疗保险数据集（SEER-Medicare dataset）中确定了 2010 年至 2015 年间诊断为<5cm 的 DCIS 且年龄≥70 岁的女性，并根据一种经过验证的基于索赔的测量方法，将预期寿命≤5 年或>5 年的患者分为两组。采用 Pearson 卡方检验比较两组间局部区域治疗（乳房切除术+腋窝手术、乳房切除术、乳房切除术+放疗+腋窝手术、乳房切除术+放疗、乳房切除术、单纯乳房切除术和无治疗）的差异。采用广义线性混合模型确定与接受单纯乳房切除术相关的因素。
在 5346 名女性中（中位年龄 75 岁，范围 70-97 岁），927 名（17.3%）预期寿命≤5 年。在 4041 名接受乳房切除术的患者中，710 名（13.3%）接受了腋窝手术。预期寿命≤5 年的患者中，更多的患者接受了单纯乳房切除术（39.4%比 27%）、单纯乳房切除术（8.1%比 5.3%）或无治疗（5.8%比 3.2%；p<0.001）。多变量分析显示，预期寿命≤5 年的女性接受单纯乳房切除术的可能性显著增加[比值比 1.90，95%可信区间（1.63-2.22）]。
预期寿命与老年 DCIS 患者局部区域治疗强度降低有关，但仍有很大一部分预期寿命≤5 年的患者接受了放疗和腋窝手术，这突出了过度治疗的潜在风险，也为老年患者局部区域治疗的降阶梯提供了机会。
