Adjuvant chemotherapy and survival in older women with hormone receptor-negative breast cancer: Assessing outcome in a population-based, observational cohort
Adjuvant chemotherapy and survival in older women with hormone receptor-negative breast cancer: Assessing outcome in a population-based, observational cohort
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DOI：
10.1200/jco.2005.03.6053
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发表时间：
2006-06-20
影响因子：
45.3
通讯作者：
Panageas, Katherine S.
中科院分区：
文献类型：
--
作者：
Elkin, Elena B.;Hurria, Arti;Panageas, Katherine S.
目的：对于老年乳腺癌患者，随机临床试验中辅助化疗的有效性证据有限。我们的目的是在一个以人群为基础的老年女性激素受体（HR）阴性乳腺癌队列中评估辅助化疗使用与生存率之间的关系。方法：我们在监测、流行病学和最终结果（SEER）癌症登记处中，对1992年至1999年诊断为hr阴性、非转移性乳腺癌的66岁及以上女性进行了研究。化疗使用在与SEER记录相关的医疗保险索赔中被确定。使用逻辑回归确定化疗使用的临床和社会人口学预测因素。使用倾向评分法和多变量比例风险回归评估化疗对生存的影响。结果5081例hr阴性乳腺癌患者中，1711例（34%）在癌症诊断后6个月内接受了化疗。化疗的使用随着年龄和合并症的增加而减少，随着诊断年份、肿瘤大小、阳性淋巴结数量和更高的肿瘤分级而增加。无论使用倾向评分还是标准多变量方法分析，辅助化疗与死亡率降低约15%相关。在淋巴结阳性疾病患者和最有可能接受化疗的淋巴结阴性患者中观察到最大的总生存获益。结论：该分析表明，老年女性hr阴性乳腺癌患者接受辅助化疗可提高生存率。化疗的益处在最有可能被选择接受治疗的患者中最为明显，包括那些有淋巴结累及或其他高风险疾病特征的患者。
PurposeFor older breast cancer patients, there is limited evidence of the efficacy of adjuvant chemotherapy from randomized clinical trials. Our goal was to assess the relationship between adjuvant chemotherapy use and survival in a large, population-based cohort of older women with hormone receptor (HR) -negative breast cancer.MethodsWe identified women age 66 and older diagnosed with HR-negative, nonmetastatic breast cancer from 1992 to 1999 in the Surveillance, Epidemiology and End Results (SEER) cancer registries. Chemotherapy use was identified in Medicare claims linked to SEER records. Clinical and sociodemographic predictors of chemotherapy use were identified using logistic regression. The effect of chemotherapy on survival was evaluated using propensity score methods and multivariable proportional hazards regression.ResultsA total of 1,711 (34%) of 5,081 women with HR-negative breast cancer received chemotherapy within 6 months of cancer diagnosis. Chemotherapy use decreased with increasing age and comorbidity, and increased with year of diagnosis, tumor size, number of positive lymph nodes, and higher tumor grade. Adjuvant chemotherapy was associated with a mortality reduction of approximately 15% whether analyzed using propensity scores or standard multivariable methods. The greatest overall survival benefit was observed in patients with node-positive disease and in the node-negative patients most likely to receive chemotherapy.ConclusionThis analysis suggests a survival benefit from adjuvant chemotherapy in older women with HR-negative breast cancer. The benefit of chemotherapy is most pronounced in the patients most likely to be selected for treatment, including those with involved lymph nodes or other high-risk disease characteristics.