Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy.
General Surgery, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
Ann Surg Oncol. 2024 Oct;31(11):7377-7391. doi: 10.1245/s10434-024-15790-z. Epub 2024 Aug 4.
The population aged ≥90 years is increasing worldwide, yet nearly 50% of elderly breast cancer (BC) patients receive suboptimal treatments, resulting in high rates of BC-related mortality. We analyzed clinical and survival outcomes of nonagenarian BC patients to identify effective treatment strategies.
This single-institution retrospective cohort study analyzed patients aged ≥90 years diagnosed with stage I-III BC between 2007 and 2018. Patients were categorized into three treatment groups: traditional surgery (TS), performed according to local guidelines; current-standard surgery (CS), defined as breast surgery without axillary surgery (in concordance with 2016 Choosing Wisely guidelines) and/or cavity shaving; and non-surgical treatment (NS). Clinicopathological features were recorded and recurrence rates and survival outcomes were analyzed.
We collected data from 113 nonagenarians with a median age of 93 years (range 90-99). Among these patients, 43/113 (38.1%) underwent TS, 34/113 (30.1%) underwent CS, and 36/113 (31.9%) underwent NS. The overall recurrence rate among surgical patients was 10.4%, while the disease progression rate in the NS group was 22.2%. Overall survival was significantly longer in surgical patients compared with NS patients (p = 0.04). BC-related mortality was significantly higher in the NS group than in the TS and CS groups (25.0% vs. 0% vs. 7.1%, respectively; p = 0.01). There were no significant differences in overall survival and disease-free survival between the TS and CS groups (p = 0.6 and p = 0.8, respectively), although the TS group experienced a significantly higher overall postoperative complication rate (p < 0.001).
Individualized treatment planning is essential for nonagenarian BC patients. Surgery, whenever feasible, remains the treatment of choice, with CS emerging as the best option for the majority of patients.
全球 90 岁以上人口数量不断增加，但近 50%的老年乳腺癌（BC）患者接受的治疗并不理想，导致 BC 相关死亡率较高。我们分析了 90 岁以上 BC 患者的临床和生存结局，以确定有效的治疗策略。
本单中心回顾性队列研究分析了 2007 年至 2018 年间诊断为 I-III 期 BC 的年龄≥90 岁的患者。患者分为三组治疗：传统手术（TS），根据当地指南进行；现行标准手术（CS），定义为不进行腋窝手术的乳房手术（与 2016 年明智选择指南一致）和/或腔刮除术；非手术治疗（NS）。记录临床病理特征，分析复发率和生存结局。
我们收集了 113 名 93 岁中位年龄（范围 90-99）的 90 岁以上非老年患者的数据。其中，43/113（38.1%）患者行 TS，34/113（30.1%）患者行 CS，36/113（31.9%）患者行 NS。手术患者的总体复发率为 10.4%，而 NS 组的疾病进展率为 22.2%。与 NS 组相比，手术组患者的总体生存率显著延长（p=0.04）。NS 组的 BC 相关死亡率显著高于 TS 和 CS 组（25.0%比 0%比 7.1%，分别；p=0.01）。TS 组和 CS 组的总体生存率和无病生存率无显著差异（p=0.6 和 p=0.8，分别），尽管 TS 组的总体术后并发症发生率显著更高（p<0.001）。
对于 90 岁以上的 BC 患者，个体化治疗方案至关重要。只要可行，手术仍然是首选治疗方法，CS 成为大多数患者的最佳选择。
