Yildirim Eda Caliskan, Atag Elif, Semiz Huseyin Salih, Unal Olcun Umit, Uzun Mehmet, Aksoy Suleyman Ozkan, Durak Merih Guray, Karaoglu Aziz
Department of Internal Medicine, Division of Medical Oncology, Dokuz Eylul University, Izmir, 35340, Turkey.
Department of Internal Medicine, Health Sciences University Izmir Faculty of Medicine, Izmir, Turkey.
Sci Rep. 2025 Mar 21;15(1):9866. doi: 10.1038/s41598-025-93203-1.
Neoadjuvant chemotherapy (NAC) is well-established for locally advanced breast cancer, even in the early stages, especially in HER2-positive and triple-negative cases. However, the effect of chronologic age on NAC response remains controversial. This study investigates the efficacy and outcomes of NAC in older patients with breast cancer, compared to a younger cohort, to address the current knowledge gap. 535 patients who received NAC followed by curative surgery from 2010 to 2021 were retrospectively analyzed. We evaluated breast and axillary downstaging, pathologic complete response (pCR), and post-treatment toxicities. Data were stratified by age, with patients aged 65 years and older representing the older group. Anthracycline-based chemotherapy was prevalent (97.6%) and favored younger patients who received a dose-dense anthracycline regimen (71.7% vs. 38.5%, p < 0.001). Surgical outcomes, breast and axillary downstaging, and the pathologic complete response showed no age-related differences. Grade 3-4 toxicity was higher in older patients (71% vs. 46.4%, p < 0.01). Older patients treated with NAC achieve comparable outcomes to younger patients, supporting personalized treatment. Chronologic age should not dictate treatment decisions, emphasizing the need for comprehensive evaluation for optimal geriatric patient care.
新辅助化疗（NAC）在局部晚期乳腺癌中已得到充分确立，即使在早期阶段也是如此，尤其是在人表皮生长因子受体2（HER2）阳性和三阴性病例中。然而， chronological age对NAC反应的影响仍存在争议。本研究调查了老年乳腺癌患者与年轻队列相比接受NAC的疗效和结果，以填补当前的知识空白。对2010年至2021年期间接受NAC后进行根治性手术的535例患者进行了回顾性分析。我们评估了乳腺和腋窝降期、病理完全缓解（pCR）以及治疗后的毒性反应。数据按年龄分层，65岁及以上的患者为老年组。基于蒽环类药物的化疗很普遍（97.6%），且更受接受剂量密集型蒽环类药物方案的年轻患者青睐（71.7%对38.5%，p<0.001）。手术结果、乳腺和腋窝降期以及病理完全缓解均未显示出与年龄相关的差异。老年患者3-4级毒性反应更高（71%对46.4%，p<0.01）。接受NAC治疗的老年患者与年轻患者取得了相当的结果，支持个性化治疗。chronological age不应决定治疗决策，强调需要进行全面评估以实现老年患者的最佳护理。
