Impact of age on breast cancer mortality and competing causes of death at 10 years follow-up in the adjuvant TEAM trial
Impact of age on breast cancer mortality and competing causes of death at 10 years follow-up in the adjuvant TEAM trial
复制标题
DOI：
10.1016/j.ejca.2018.04.009
复制
发表时间：
2018-08-01
影响因子：
8.4
通讯作者：
Liefers, G. J.
中科院分区：
文献类型：
--
作者：
Derks, M. G. M.;Bastiaannet, E.;Liefers, G. J.
目的：由于预期寿命的增加，乳腺癌患者在很长一段时间内仍有死于乳腺癌的风险。本研究旨在评估年龄对乳腺癌死亡率和其他原因死亡率的影响10 years after diagnosis.Methods：绝经后乳腺癌患者的三苯氧胺和依西美坦佐剂多国（TEAM）试验在2001年和2006年。诊断时的年龄分类为≥ 75岁（n = 854）。乳腺癌死亡率评估考虑其他原因的死亡率作为竞争事件使用竞争风险analysis.Results：经过中位随访9.8年（四分位数范围8.0-10.3），乳腺癌死亡率的累积发病率随年龄增加（年龄= 75岁，15.6%（13.1-18.0））。单变量亚分布风险比（sHR）随年龄增加而增加（年龄：65-74岁，sHR：1.08，95% CI：0.92-1.27和≥ 75岁sHR：1.30，95% CI：1.06-1.58，P = 0.013）。根据肿瘤和治疗特征调整的多变量sHR随年龄增加而增加，但未达到显著性（年龄65-74岁，sHR：1.11，95% CI：0.94-1.31; >75岁，sHR：1.18，95% CI：0.94-1.48，P = 0.055）。在单变量分析中，诊断后10年，诊断时年龄较大与乳腺癌死亡率增加相关，但在多变量分析中没有达到显著性。这并没有被年龄较大的其他原因死亡率高得多所抵消。这强调了需要改善老年乳腺癌患者治疗不足和过度治疗之间的平衡。该试验已在国际试验数据库中注册（ClinicalTrials.gov NCT 00279448、NCT 00032136和NCT 00036270;荷兰试验注册中心NTR 267）。(C)2018爱思唯尔有限公司版权所有
Aim: Due to increasing life expectancy, patients with breast cancer remain at risk of dying due to breast cancer over a long time. This study aims to assess the impact of age on breast cancer mortality and other cause mortality 10 years after diagnosis.Methods: Postmenopausal patients with hormone-receptor positive breast cancer were included in the Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial between 2001 and 2006. Age at diagnosis was categorised as = 75 years (n = 854). Breast cancer mortality was assessed considering other cause mortality as competing event using competing risk analysis.Results: After a median follow-up of 9.8 years (interquartile range 8.0-10.3), cumulative incidence of breast cancer mortality increased with increasing age (age = 75 years, 15.6% (13.1-18.0)). Univariate subdistribution hazard ratio (sHR) increased with increasing age (age: 65-74 years, sHR: 1.08, 95% CI: 0.92-1.27 and >= 75 years sHR: 1.30, 95% CI: 1.06-1.58, P = 0.013). Multivariable sHR adjusted for tumour and treatment characteristics increased with age but did not reach significance (age 65-74 years, sHR: 1.11, 95% CI: 0.94-1.31; >75 years, sHR: 1.18, 95% CI: 0.94-1.48, P = 0.055).Conclusion: Ten years after diagnosis, older age at diagnosis is associated with increasing breast cancer mortality in univariate analysis, but it did not reach significance in multivariable analysis. This is not outweighed by a substantially higher other cause mortality with older age. This underlines the need to improve the balance between undertreatment and overtreatment in older patients with breast cancer. The trial was registered in International Trial Databases (ClinicalTrials.gov NCT00279448, NCT00032136, and NCT00036270; the Netherlands Trial Registry NTR267). (C) 2018 Elsevier Ltd. All rights reserved.