Ahmed Buraq, Al-Khames Aga Qutaiba, Cheung Kwok-Leung, de Boniface Jana, Gnant Michael, Cardoso Maria-Joao, Rakha Emad, Elumalai Thiraviyam, Harbeck Nadia, Kaidar-Person Orit, Agrawal Amit
Medical School, University of Cambridge, Cambridge, United Kingdom.
Breast Surgery, Cambridge University Hospitals, Cambridge, United Kingdom.
JNCI Cancer Spectr. 2025 Apr 30;9(3). doi: 10.1093/jncics/pkaf049.
BACKGROUND: Although the relative proportion of triple-negative breast cancer decreases with age, its prevalence is rising with an aging population. This study examined real-world treatment practices, whether age in older women with triple-negative breast cancer affects therapy and outcomes, focusing on the potentially curable nature of early-stage triple-negative breast cancer. METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA-compliant search using population, intervention, comparison, outcomes criteria identified literature from 2014 to 2023 across 5 databases (MEDLINE, Embase, PubMed, Web of Science, and Scopus), focusing on women aged 65 years and older with early-stage triple-negative breast cancer. RESULTS: From 7171 records, 37 studies were included. Older women with triple-negative breast cancer exhibited less aggressive features, including lower Ki67, higher androgen receptor, and higher Bcl2 expression. Breast-conserving surgery with radiation therapy (RT) was associated with improved overall survival and breast cancer-specific survival, with fewer recurrences compared with mastectomy with or without RT. Older women with triple-negative breast cancer were more likely to receive RT than systemic therapy, and the lack of RT correlated with worse outcomes. Multivariate analyses showed that systemic treatment improved 5-year overall survival and breast cancer-specific survival. Overall, outcomes did not show significant differences between women aged 70 years and older and women younger than 70 years at a median follow-up of 46 months. CONCLUSIONS: The lack of overall outcome improvements for older women with triple-negative breast cancer following treatment may not solely be due to absent targetable receptors because the intrinsic biology in older patients may be relatively favorable. Instead, treatment selection biases against active treatment due to age-related factors may contribute substantially. Treatment decisions should be biology based and guided by a multidisciplinary, holistic, and patient-centered approach that carefully considers comorbidities, functional status, social support, and patient preferences.
背景：尽管三阴性乳腺癌的相对比例随年龄增长而降低，但其患病率却随着人口老龄化而上升。本研究考察了实际治疗情况，即老年三阴性乳腺癌女性的年龄是否会影响治疗和预后，重点关注早期三阴性乳腺癌的潜在可治愈性。 方法：采用系统评价和Meta分析的首选报告项目（PRISMA），使用人群、干预措施、对照、结局标准进行检索，从2014年至2023年的5个数据库（MEDLINE、Embase、PubMed、科学网和Scopus）中筛选文献，重点关注65岁及以上的早期三阴性乳腺癌女性。 结果：从7171条记录中，纳入了37项研究。老年三阴性乳腺癌女性表现出侵袭性较低的特征，包括较低的Ki67、较高的雄激素受体和较高的Bcl2表达。保乳手术联合放疗与总体生存率和乳腺癌特异性生存率的提高相关，与乳房切除术（无论是否联合放疗）相比，复发较少。老年三阴性乳腺癌女性接受放疗的可能性高于全身治疗，未接受放疗与较差的预后相关。多变量分析表明，全身治疗可提高5年总体生存率和乳腺癌特异性生存率。总体而言，在中位随访46个月时，70岁及以上女性与70岁以下女性的结局无显著差异。 结论：老年三阴性乳腺癌女性治疗后总体结局未改善，可能并非仅仅是由于缺乏可靶向的受体，因为老年患者的内在生物学特性可能相对较好。相反，与年龄相关的因素导致的治疗选择偏向于不进行积极治疗，可能是主要原因。治疗决策应以生物学为基础，并以多学科、整体和以患者为中心的方法为指导，仔细考虑合并症、功能状态、社会支持和患者偏好。
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