Petrelli Fausto, Dottorini Lorenzo, Sarno Italo, Di Menna Giandomenico, Angeli Irene, Moleri Giovanna, Battaiotto Elena, Luciani Andrea
Oncology Unit, ASST Bergamo ovest, Treviglio, Italy.
Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Italy.
Tumori. 2025 Apr;111(2):121-132. doi: 10.1177/03008916241310991. Epub 2025 Jan 30.
Evidence from randomized trials regarding adjuvant chemotherapy and its impact on survival in older patients with resected breast cancer is limited. This study evaluates the current evidence on the use of adjuvant chemotherapy and its effects on overall mortality and breast cancer-specific mortality in older patients. A systematic review and meta-analysis were conducted on the impact of adjuvant chemotherapy in elderly patients with HER2-negative breast cancer. Searches in PubMed, Embase, and The Cochrane Library up to May 2024 included terms such as "breast cancer," "adjuvant," "chemotherapy," "elderly," and "HER2-negative." Eligible studies involved women aged 65 years or older with HER2-negative breast cancer, comparing those receiving adjuvant chemotherapy versus those who did not. Excluded were studies on neoadjuvant therapy, HER2-positive disease, or non-English publications. The primary outcome was overall mortality. Among 2345 articles, 35 studies met the inclusion criteria, comprising 376,900 patients. Adjuvant chemotherapy significantly reduced overall mortality (hazard ratio [HR] = 0.73; 95% CI: 0.68-0.78) and breast cancer-specific mortality (HR = 0.81; 95% CI: 0.73-0.9), with the most pronounced benefit in triple-negative breast cancer (HR = 0.63; 95% CI: 0.60-0.67). Adjuvant chemotherapy reduces overall mortality and breast cancer-specific mortality in older patients, particularly those with triple-negative breast cancer. However, the evidence is predominantly based on retrospective or observational studies, highlighting inherent limitations. Comprehensive geriatric evaluations are crucial for patient selection, and dedicated clinical trials focused on older populations are urgently needed.
关于辅助化疗及其对老年乳腺癌切除患者生存影响的随机试验证据有限。本研究评估了目前关于辅助化疗的使用及其对老年患者总体死亡率和乳腺癌特异性死亡率影响的证据。对HER2阴性老年乳腺癌患者辅助化疗的影响进行了系统评价和荟萃分析。截至2024年5月在PubMed、Embase和Cochrane图书馆进行检索，检索词包括“乳腺癌”、“辅助”、“化疗”、“老年人”和“HER2阴性”。符合条件的研究涉及65岁及以上的HER2阴性乳腺癌女性，比较接受辅助化疗的患者与未接受辅助化疗的患者。排除新辅助治疗、HER2阳性疾病或非英文出版物的研究。主要结局是总体死亡率。在2345篇文章中，35项研究符合纳入标准，共376,900例患者。辅助化疗显著降低了总体死亡率（风险比[HR]=0.73；95%置信区间：0.68-0.78）和乳腺癌特异性死亡率（HR=0.81；95%置信区间：0.73-0.9），在三阴性乳腺癌中获益最为显著（HR=0.63；95%置信区间：0.60-0.67）。辅助化疗可降低老年患者的总体死亡率和乳腺癌特异性死亡率，尤其是三阴性乳腺癌患者。然而，证据主要基于回顾性或观察性研究，突出了其固有的局限性。全面的老年综合评估对于患者选择至关重要，迫切需要针对老年人群的专门临床试验。
