Merchant T E, McCormick B, Yahalom J, Borgen P
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York 10021, USA.
Int J Radiat Oncol Biol Phys. 1996 Feb 1;34(3):565-70. doi: 10.1016/0360-3016(95)02167-1.
Information concerning the differences between older and younger women with breast cancer, treated with standard therapy, is lacking from many prospective series. The purpose of this study is to identify factors that influence treatment decisions and determine if women age 65 and older are treated differently than younger women. The outcomes of older women would then be compared to younger to determine if treatment differences influence outcome.
The records of 558 women with early invasive breast cancer who were treated with breast conserving surgery and radiation therapy were retrospectively reviewed. Four hundred thirty-two women under the age of 65 (range: 24-64) and 126 women age 65 and older (range: 65-85) were assessed for treatment differences including breast reexcision, extent of axillary dissection, extent of breast and nodal irradiation, and the use of chemotherapy or hormonal therapy. Differences in the treatment of the two groups were determined and the end points of local control, disease-free survival, and overall survival were compared. Median follow-up was 5.5 years.
The two treatment groups had identical pathologic TNM staging with the exception that 21% of the older age group and 5% of the younger group did not undergo axillary dissection. Women age 65 and older were less likely to have a reexcision, extensive axillary dissection, chemotherapy, or nodal irradiation. They were more likely to receive hormonal therapy. Reexcision in older women was positively influenced by a family history of breast cancer and negatively influenced by a history of previous malignancy. None of the patients who were treated without and axillary dissection suffered a regional recurrence. Although local control was better in older patients, there were no differences in disease-free or overall survival for the two groups.
The findings of this study reveal that older patients have significant treatment differences as compared to younger patients; however, despite these differences, similar local control and survival were achieved at 5 to 10 years. With the expected survival of older women increasing, the prospective evaluation of treatment options for older women should be considered.
许多前瞻性研究系列缺乏关于接受标准治疗的老年和年轻乳腺癌女性之间差异的信息。本研究的目的是确定影响治疗决策的因素，并确定65岁及以上女性与年轻女性的治疗方式是否不同。然后将老年女性的结果与年轻女性进行比较，以确定治疗差异是否影响结果。
回顾性分析了558例接受保乳手术和放射治疗的早期浸润性乳腺癌女性的记录。评估了432例65岁以下（范围：24 - 64岁）和126例65岁及以上（范围：65 - 85岁）女性的治疗差异，包括乳房再次切除、腋窝清扫范围、乳房和淋巴结照射范围以及化疗或激素治疗的使用情况。确定了两组治疗的差异，并比较了局部控制、无病生存和总生存的终点。中位随访时间为5.5年。
两个治疗组的病理TNM分期相同，不同之处在于老年组的21%和年轻组的5%未进行腋窝清扫。65岁及以上的女性进行再次切除、广泛腋窝清扫、化疗或淋巴结照射的可能性较小。她们更有可能接受激素治疗。老年女性的再次切除受乳腺癌家族史的积极影响，受既往恶性肿瘤病史的消极影响。所有未进行腋窝清扫的患者均未发生区域复发。尽管老年患者的局部控制更好，但两组的无病生存或总生存没有差异。
本研究结果表明，与年轻患者相比，老年患者存在显著的治疗差异；然而，尽管存在这些差异，在5至10年时仍实现了相似的局部控制和生存。随着老年女性预期寿命的增加，应考虑对老年女性的治疗选择进行前瞻性评估。
