Korzets Yasmin, Khatib Marian, Goldvaser Hadar, Hibshoosh Yehiel, Nikolaevski-Berlin Alla, Wolf Ido, Soyfer Viacheslav
Institute of Oncology,Tel Aviv Sourasky Medical Center, Weizmann St 6, Tel Aviv, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
World J Surg Oncol. 2025 Jan 3;23(1):3. doi: 10.1186/s12957-024-03635-8.
De-intensification of anti-cancer therapy without significantly affecting outcomes is an important goal. Omission of axillary surgery or breast radiation is considered a reasonable option in elderly patients with early-stage breast cancer and good prognostic factors. Data on avoidance of both axillary surgery and radiation therapy (RT) is scarce and inconclusive.
A retrospective cohort study comprising all women aged 70 years and older diagnosed with early, hormone receptor (HR) positive, HER2-negative breast cancer treated with breast-conserving surgery (BCS) without sentinel lymph node biopsy (SLNB) and RT in a large tertiary center (between 2016 and 2021). Data on patient and tumor characteristics as well as outcomes including local recurrence, loco-regional recurrence, distant metastases, and death were extracted. Disease free survival (DFS) was assessed by Kaplan-Meier analysis. The Cox proportional hazard regression model was performed to identify factors (demographic and clinical characteristics of the patients) that predict the disease recurrence or death.
A total of 100 women were included, median age of patients was 81. All patients had clinically node-negative disease with a median tumor size was 13 mm. Five (5%) women had lymphovascular invasion. At a median follow-up of 3.9 years, there were 7 (7%) recurrences, 4 local, 2 local-regional, and one distant. The median DFS for the entire group was 42 months (11-128). Eight patients (8%) died, 5 of them for reasons unrelated to breast cancer (3 of unknown reason). Tumor size larger than 13 mm was associated with significantly worse DFS (HR = 4.02, 95% CI 1.08-14.99, p = 0.04).
Omission of both SLNB and adjuvant RT is feasible in elderly, early breast cancer patients with small luminal tumors.
在不显著影响治疗结果的情况下减少抗癌治疗强度是一个重要目标。对于具有良好预后因素的老年早期乳腺癌患者，省略腋窝手术或乳腺放疗被认为是一种合理的选择。关于同时避免腋窝手术和放射治疗（RT）的数据稀少且尚无定论。
一项回顾性队列研究，纳入了在一家大型三级中心（2016年至2021年期间）被诊断为早期、激素受体（HR）阳性、人表皮生长因子受体2（HER2）阴性乳腺癌且接受了保乳手术（BCS）但未进行前哨淋巴结活检（SLNB）和放疗的所有70岁及以上女性。提取了患者和肿瘤特征以及包括局部复发、区域复发、远处转移和死亡在内的治疗结果的数据。通过Kaplan-Meier分析评估无病生存期（DFS）。采用Cox比例风险回归模型来确定预测疾病复发或死亡的因素（患者的人口统计学和临床特征）。
共纳入100名女性，患者的中位年龄为81岁。所有患者临床检查淋巴结均为阴性，肿瘤大小中位数为13毫米。5名（5%）女性有淋巴管浸润。中位随访3.9年时，有7例（7%）复发，4例为局部复发，2例为区域复发，1例为远处复发。整个组的中位DFS为42个月（11 - 128个月）。8例（8%）患者死亡，其中5例死亡原因与乳腺癌无关（3例原因不明）。肿瘤大小大于13毫米与显著更差的DFS相关（风险比[HR]=4.02，95%置信区间[CI] 1.08 - 14.99，p = 0.04）。
对于患有小腔隙性肿瘤的老年早期乳腺癌患者，省略SLNB和辅助放疗是可行的。
