Chen Sheng, Zhou Xiaoyun, Yang Li, Xu Ting, Xu Guoping, Chen Shujie, Wang Jie
Department of Breast Surgery, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China.
Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China.
Sci Rep. 2025 Jul 1;15(1):21609. doi: 10.1038/s41598-025-03592-6.
Current guidelines lack definitive recommendations on the use of chemotherapy for early-stage breast cancer in patients aged over 70. Clinical decision-making on chemotherapy for elderly breast cancer remains challenging because of insufficient large-scale, long-term outcomes. We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results database from 2010 to 2020 to investigate early-stage breast infiltrating ductal carcinoma in patients aged 70 to 79. Propensity score matching (PSM) with a ratio of 1:1 and caliper of 0.02 standard deviation of propensity score was employed to address covariate imbalance. Univariate and multivariate analyses were performed to assess the impact of chemotherapy on breast cancer-specific survival (BCSS) and overall survival (OS). We identified a total of 11,792 patients with complete information about breast cancer, who underwent surgical treatment and received systemic therapy after surgery. Among them, 3,490 patients received chemotherapy. After PSM, we obtained a matched cohort consisting of 3,156 patients where the characteristics between the two groups were balanced except for molecular subtypes. In the matched dataset, no significant differences were observed in BCSS (P = 0.118) and OS (P = 0.119) between the two groups based on Kaplan-Meier survival analysis. Similarly, multivariate COX analysis revealed that chemotherapy did not significantly reduce the risk of BCSS (HR: 1.212; 95% CI: [0.958-1.533], P = 0.109) and OS (HR: 0.888; 95% CI: [0.765-1.031], P = 0.12). Stratified analyses based on molecular subtypes revealed that chemotherapy did not confer a favorable prognosis in patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2(HER2)-negative breast cancer in stages I and IIa, as well as in patients with HR+HER2+ breast cancer in stages I. Chemotherapy may not confer a discernible benefit for all elderly patients with breast cancer. Nevertheless, de-escalating chemotherapy could be considered as a preferable alternative for older individuals diagnosed with HR+HER2- breast cancer in stages I and IIa or HR+HER2+ breast cancer in stages I.
目前的指南对于70岁以上早期乳腺癌患者使用化疗缺乏明确的建议。由于缺乏足够的大规模长期结果，老年乳腺癌化疗的临床决策仍然具有挑战性。我们使用2010年至2020年的监测、流行病学和最终结果数据库进行了一项回顾性队列研究，以调查70至79岁的早期乳腺浸润性导管癌患者。采用倾向评分匹配（PSM），比例为1:1，卡尺为倾向评分标准差的0.02，以解决协变量不平衡问题。进行单因素和多因素分析，以评估化疗对乳腺癌特异性生存（BCSS）和总生存（OS）的影响。我们共识别出11792例有完整乳腺癌信息的患者，这些患者接受了手术治疗并在术后接受了全身治疗。其中，3490例患者接受了化疗。经过PSM后，我们获得了一个由3156例患者组成的匹配队列，除分子亚型外，两组之间的特征是平衡的。在匹配的数据集中，根据Kaplan-Meier生存分析，两组之间在BCSS（P = 0.118）和OS（P = 0.119）方面没有观察到显著差异。同样，多因素COX分析显示，化疗并没有显著降低BCSS（HR：1.212；95%CI：[0.958 - 1.533]，P = 0.109）和OS（HR：0.888；95%CI：[0.765 - 1.031]，P = 0.12）的风险。基于分子亚型的分层分析显示，化疗对于I期和IIa期激素受体（HR）阳性、人表皮生长因子受体2（HER2）阴性乳腺癌患者以及I期HR + HER2 +乳腺癌患者并没有带来良好的预后。化疗可能并非对所有老年乳腺癌患者都有明显益处。然而，对于诊断为I期和IIa期HR + HER2 -乳腺癌或I期HR + HER2 +乳腺癌的老年患者，降低化疗强度可被视为一种更可取的选择。
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