Prognostic impact of breast cancer subtypes in elderly patients.
Prognostic impact of breast cancer subtypes in elderly patients.
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DOI：
10.1007/s10549-016-3787-y
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发表时间：
2016-05
影响因子：
3.8
通讯作者：
Bartsch R
中科院分区：
文献类型：
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作者：
Bergen ES;Tichy C;Berghoff AS;Rudas M;Dubsky P;Bago-Horvath Z;Mader RM;Exner R;Gnant M;Zielinski CC;Steger GG;Preusser M;Bartsch R
我们的目的是分析乳腺癌（BC）亚型对疾病临床病程的影响，特别强调老年BC人群脑转移（BM）的发生和结局。从BC数据库中确定了2007年至2011年期间接受BC治疗的706例≥65岁患者。排除了62例诊断为DCIS的患者和73例数据集不完整的患者，留下571例患者进行分析。通过回顾性图表审查获得患者特征、生物学肿瘤亚型和临床结局（包括总生存期（OS））。380/571例（66.5%）65-74岁的患者被分组为高龄患者，182/571例（31.9%）75-84岁的患者被分组为高龄患者，29/571例（5.1%）≥85岁的患者被分组为高龄患者。392/571（68.8%）例患者出现管腔型BC，119/571（20.8%）例患者出现HER 2阳性，59/571（10.3%）例患者出现三阴性BC（TNBC）。中位随访38个月时，115/571（20.1%）例患者出现远处复发。与TNBC（15/59（25.4%））和管腔BC（57/392（14.5%）; p < 0.001）相比，在HER 2阳性亚型（43/119（36.1%））中观察到更高的复发率。与TNBC（2/59（3.4%））和管腔BC患者（6/392（1.5%）; p = 0.003）相比，在HER 2阳性BC患者（9/119（7.6%））中以显著更高的比率检测到BM。在时间依赖性协变量考克斯回归模型中，转移性疾病的诊断（HR 7.7; 95% CI 5.2-11.4; p < 0.001）以及BM的发展（HR 3.5; 95% CI 1.9-6.4; p < 0.001）对OS具有显著的负面影响。与年轻的BC患者相比，这个大型老年患者队列的结果表明，HER 2阳性疾病-而不是TNBC-具有最具侵略性的临床过程，转移性扩散和BM的发生率最高。因此，有必要对老年人TNBC的潜在独特生物学进行深入分析。
We aimed to analyse the impact of breast cancer (BC) subtypes on the clinical course of disease with special emphasis on the occurrence of brain metastases (BM) and outcome in an elderly BC population. A total number of 706 patients ≥65 years receiving treatment for BC from 2007 to 2011 were identified from a BC database. 62 patients diagnosed with DCIS and 73 patients with incomplete datasets were excluded, leaving 571 patients for this analysis. Patient characteristics, biological tumour subtypes, and clinical outcome including overall survival (OS) were obtained by retrospective chart review. 380/571 (66, 5 %) patients aged 65–74 years were grouped among the young-old, 182/571 (31.9 %) patients aged 75–84 years among the old–old, and 29/571 (5.1 %) patients aged ≥85 years among the oldest-old. 392/571 (68.8 %) patients presented with luminal BC, 119/571 (20.8 %) with HER2-positive, and 59/571 (10.3 %) with triple-negative BC (TNBC). At 38 months median follow-up, 115/571 (20.1 %) patients presented with distant recurrence. A higher recurrence rate was observed in the HER2-positive subtype (43/119 (36.1 %)), as compared to TNBC (15/59 (25.4 %)) and luminal BC (57/392 (14.5 %); p < 0.001). BM were detected at a significantly higher rate in HER2-positive BC patients (9/119 (7.6 %)), as compared to TNBC (2/59 (3.4 %)) and luminal BC patients (6/392 (1.5 %); p = 0.003). Diagnosis of metastatic disease (HR 7.7; 95 % CI 5.2–11.4; p < 0.001) as well as development of BM (HR 3.5; 95 % CI 1.9–6.4; p < 0.001) had a significantly negative impact on OS in a time-dependent covariate cox regression model. In contrast to younger BC patients, outcome in this large cohort of elderly patients suggests that HER2-positive disease—not TNBC—featured the most aggressive clinical course with the highest rates of metastatic spread and BM. In-depth analysis regarding a potentially distinct biology of TNBC in elderly is therefore warranted.