Breast Cancer Among the Oldest Old: Tumor Characteristics, Treatment Choices, and Survival
Breast Cancer Among the Oldest Old: Tumor Characteristics, Treatment Choices, and Survival
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DOI：
10.1200/jco.2009.25.9796
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发表时间：
2010-04-20
影响因子：
45.3
通讯作者：
McCarthy, Ellen P.
中科院分区：
文献类型：
--
作者：
Schonberg, Mara A.;Marcantonio, Edward R.;McCarthy, Ellen P.
研究目的：关于80岁以上女性乳腺癌的特征、治疗和生存率的数据很少，我们使用了1992年至2003年的监测、流行病学和最终结果-医疗保险数据集，（乳房切除术、保乳手术[BCS]联合放疗或单独或不手术），以及80岁或以上女性的结局（80至84岁，85至89岁，>= 90岁）与年轻女性（67至79岁）相比，患有I/II期乳腺癌。我们使用考克斯比例风险模型来研究年龄对乳腺癌相关和其他死亡原因的影响。在阶段内进行分析，调整肿瘤和社会人口学特征，接受的治疗，和comorbidity.ResultsIn总数，49,616名妇女年龄67岁或以上的阶段I/II疾病。各年龄组的肿瘤特征（分级、激素受体）相似。BCS单独治疗随着年龄的增长而增加，特别是80岁以后。死于乳腺癌的风险随着年龄的增长而增加，在80岁以后显著增加。对于I期疾病，年龄≥ 90岁的女性与年龄67至69岁的女性相比，死于乳腺癌的校正风险比为2.6（范围为2.0至3.4）。接受的治疗类型与年龄和合并症显著相关，年龄作为更强的预测因素（26%的年龄>= 80岁无合并症的女性接受BCS单独治疗或不接受手术，而67 - 79岁的女性仅为6%）。80岁的女性乳腺癌的特征与年轻女性相似，但接受的治疗不那么积极，早期死亡率更高。乳腺癌分期未来的研究应该集中在确定肿瘤和患者的特征，以帮助最有可能受益的老年女性进行靶向治疗。J Clin Oncol 28：2038-2045. (C)2010年美国临床肿瘤学会
PurposeFew data are available on breast cancer characteristics, treatment, and survival for women age 80 years or older.Patients and MethodsWe used the linked Surveillance, Epidemiology and End Results-Medicare data set from 1992 to 2003 to examine tumor characteristics, treatments (mastectomy, breast-conserving surgery [BCS] with radiation therapy or alone, or no surgery), and outcomes of women age 80 years or older (80 to 84, 85 to 89, >= 90 years) with stage I/II breast cancer compared with younger women (age 67 to 79 years). We used Cox proportional hazard models to examine the impact of age on breast cancer-related and other causes of death. Analyses were performed within stage, adjusted for tumor and sociodemographic characteristics, treatments received, and comorbidities.ResultsIn total, 49,616 women age 67 years or older with stage I/II disease were included. Tumor characteristics (grade, hormone receptivity) were similar across age groups. Treatment with BCS alone increased with age, especially after age 80. The risk of dying from breast cancer increased with age, significantly after age 80. For stage I disease, the adjusted hazard ratio of dying from breast cancer for women age >= 90 years compared with women age 67 to 69 years was 2.6 (range, 2.0 to 3.4). Types of treatments received were significantly associated with age and comorbidity, with age as the stronger predictor (26% of women age >= 80 years without comorbidity received BCS alone or no surgery compared with 6% of women age 67 to 79 years).ConclusionWomen age >= 80 years have breast cancer characteristics similar to those of younger women yet receive less aggressive treatment and experience higher mortality from early-stage breast cancer. Future studies should focus on identifying tumor and patient characteristics to help target treatments to the oldest women most likely to benefit. J Clin Oncol 28: 2038-2045. (C) 2010 by American Society of Clinical Oncology