60岁及以上亚洲乳腺癌患者放疗的肿瘤部位、分期及受体特异性疗效：一项纳入临床病理特征和列线图的监测、流行病学与结果（SEER）数据库生存分析

Tumor site, stage, and receptor-specific efficacy of radiation therapy in Asian breast cancer patients aged 60 years and older: A SEER database survival analysis incorporating clinicopathological features and nomograms.

作者信息

Mao Qixin, Han Haonan, Li Lianfang, Liu Shanqing, Li Yong, Shen Yan, Guo Leiming, Xu Liming

机构信息

Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.

Hubei Key Laboratory of Tumor Microenvironment and Immunotherapy, College of Basic Medical Sciences, China Three Gorges University, Yichang, China.

出版信息

Breast. 2025 Jun 10;82:104518. doi: 10.1016/j.breast.2025.104518.

DOI:10.1016/j.breast.2025.104518

PMID:40540937

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12221680/

Abstract

PURPOSE

This study evaluates the survival benefits of radiation therapy (RT) in elderly (≥60 years) Asian breast cancer patients focusing on tumor site, stage, and receptor status using SEER data. And aims to provide a nuanced understanding of how RT impacts survival outcomes in this demographic, particularly across varying tumor stages and receptor statuses.

METHODS

We analyzed 47,868 elderly (≥60 years) Asian patients from the SEER database (2000-2021). Survival outcomes were assessed using Kaplan-Meier analysis, Cox regression models, and nomograms. Multivariate analyses quantified RT efficacy across tumor sites (central, axillary tail), hormone receptor status (ER/PR, HER2), and stages (I-IV).

RESULTS

RT improved median overall survival (OS) (17.5 vs. 13.4 years; hazard ratio [HR] = 0.54, p < 0.001), with consistent benefits across delivery methods. Axillary tail tumors showed the greatest survival gain (64.2 % OS improvement, HR = 0.36). ER/PR-positive patients derived significant benefit (HR = 0.48), unlike HER2-positive cases (p = 0.12). Stage III patients experienced maximal survival improvement (HR = 0.41), while stage IV showed marginal benefits (HR = 0.89). Age-stratified analyses confirmed benefits across all groups (60-69, 70-79, ≥80 years).

CONCLUSION

RT confers significant survival benefits in elderly (≥60 years) Asian breast cancer patients, with pronounced efficacy observed in axillary tail tumors and stage III disease. ER/PR-positive tumors exhibit enhanced treatment responsiveness, while HER2 status remains non-predictive of therapeutic outcomes. However, limited efficacy in stage IV disease underscores the necessity for alternative management strategies in advanced-stage settings. These findings emphasized personalizing RT guided by tumor biology and staging, while carefully considering comorbidities and treatment-related toxicities in geriatric oncology populations.

摘要

目的

本研究利用监测、流行病学与最终结果（SEER）数据库评估放射治疗（RT）对老年（≥60岁）亚洲乳腺癌患者的生存获益，重点关注肿瘤部位、分期和受体状态。旨在更细致地了解放疗如何影响这一人群的生存结局，尤其是在不同肿瘤分期和受体状态下。

方法

我们分析了SEER数据库（2000 - 2021年）中的47868例老年（≥60岁）亚洲患者。使用Kaplan - Meier分析、Cox回归模型和列线图评估生存结局。多变量分析量化了放疗在不同肿瘤部位（中央、腋窝尾部）、激素受体状态（雌激素受体/孕激素受体[ER/PR]、人表皮生长因子受体2[HER2]）和分期（I - IV期）的疗效。

结果

放疗改善了中位总生存期（OS）（17.5年对13.4年；风险比[HR]=0.54，p<0.001），不同放疗方式均有一致的获益。腋窝尾部肿瘤的生存获益最大（OS改善64.2%，HR = 0.36）。ER/PR阳性患者获益显著（HR = 0.48），而HER2阳性患者则不然（p = 0.12）。III期患者的生存改善最大（HR = 0.41），而IV期患者的获益较小（HR = 0.89）。年龄分层分析证实了所有年龄组（60 - 69岁、70 - 79岁、≥80岁）均有获益。

结论

放疗对老年（≥60岁）亚洲乳腺癌患者有显著的生存获益，在腋窝尾部肿瘤和III期疾病中观察到明显疗效。ER/PR阳性肿瘤对治疗反应性增强，而HER2状态对治疗结局无预测性。然而，IV期疾病的疗效有限，凸显了晚期情况下采用替代管理策略的必要性。这些发现强调根据肿瘤生物学和分期进行放疗个体化，同时在老年肿瘤人群中仔细考虑合并症和治疗相关毒性。