Lorentzen Eliza H, Chen Yu-Jen, Jones Annabelle L, Kantor Olga, King Tari A, Mittendorf Elizabeth A, Minami Christina A
Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
Breast Cancer Res Treat. 2025 May 20. doi: 10.1007/s10549-025-07728-0.
Treatment guidelines recommend multimodal therapy for non-metastatic high-risk breast cancer in older adults. However, older patients may be less likely to receive this due to varying abilities to withstand intensive therapy. We aimed to quantify the incidence of, factors associated with, and reasons behind omission of multimodal therapy in older high-risk breast cancer patients.
Women ≥ 70 years diagnosed with stage 2-3 HR-/HER2+ or triple-negative breast cancer were identified in the National Cancer Database, 2010-2020. Multimodal therapy was defined as surgery and systemic therapy; omission of multimodal therapy was defined as patients who did not receive one or both therapies. Chi-square tests were used to assess differences by therapy intensity. Multivariable logistic regression models adjusting for patient and disease-level characteristics were performed to determine the factors associated with therapy omission.
Of 22,644 patients, 63.4% were ≤ 80 years old. Overall, 59.7% received multimodal therapy, 35.3% received either surgery or systemic therapy, and 5.0% received no therapy. Factors significantly associated with increased likelihood of multimodal therapy omission included increased age, Black race, Medicaid or uninsured status, and higher Charlson Comorbidity Index scores. The most common reason for omission was that it was "not part of planned treatment," (59.2% for omission of surgery, 52.4% for omission of systemic therapy), with patient refusal (17.4% for omission of surgery, 28.3% for omission of systemic therapy) being second most common.
While most older patients received multimodal therapy, demographic and socioeconomic factors associated with treatment omission suggest that some vulnerable women with high-risk disease may be undertreated.
治疗指南推荐对老年非转移性高危乳腺癌患者采用多模式治疗。然而，由于老年患者承受强化治疗的能力各不相同，他们接受这种治疗的可能性可能较低。我们旨在量化老年高危乳腺癌患者多模式治疗的遗漏发生率、相关因素及背后原因。
在国家癌症数据库中识别出2010年至2020年期间诊断为2-3期HR-/HER2+或三阴性乳腺癌的70岁及以上女性。多模式治疗定义为手术和全身治疗；多模式治疗的遗漏定义为未接受其中一种或两种治疗的患者。采用卡方检验评估不同治疗强度的差异。进行多变量逻辑回归模型，对患者和疾病层面的特征进行调整，以确定与治疗遗漏相关的因素。
在22644例患者中，63.4%年龄≤80岁。总体而言，59.7%的患者接受了多模式治疗，35.3%的患者接受了手术或全身治疗，5.0%的患者未接受任何治疗。与多模式治疗遗漏可能性增加显著相关的因素包括年龄增加、黑人种族、医疗补助或无保险状态以及较高的查尔森合并症指数评分。遗漏的最常见原因是“不属于计划治疗的一部分”（手术遗漏为59.2%，全身治疗遗漏为52.4%），患者拒绝（手术遗漏为17.4%，全身治疗遗漏为28.3%）是第二常见原因。
虽然大多数老年患者接受了多模式治疗，但与治疗遗漏相关的人口统计学和社会经济因素表明，一些患有高危疾病的弱势女性可能未得到充分治疗。
