Undertreatment strongly decreases prognosis of breast cancer in elderly women
Undertreatment strongly decreases prognosis of breast cancer in elderly women
复制标题
DOI：
10.1200/jco.2003.02.046
复制
发表时间：
2003-10-01
影响因子：
45.3
通讯作者：
Vlastos, G
中科院分区：
文献类型：
--
作者：
Bouchardy, C;Rapiti, E;Vlastos, G
目的：老年癌症患者的治疗尚未达成共识。治疗受到不明确标准的影响，通常不太积极。本研究旨在评估老年patients.Patients和方法乳腺癌预后的治疗选择的决定因素和效果：我们回顾了407例年龄大于或等于80岁的乳腺癌患者的临床档案记录在日内瓦癌症登记处1989年和1999年之间。考虑患者和肿瘤特征、一般健康状况、合并症、治疗和死亡原因。我们评估了治疗的决定因素的logistic回归和治疗效果的死亡率的考克斯模型，占预后factors.Results：年龄是独立的治疗类型。总体而言，12%的女性（n = 48）未接受治疗，32%（n = 132）仅接受他莫昔芬治疗，7%（n = 28）仅接受保乳手术，33%（n = 133）接受乳房切除术，14%（n = 57）接受保乳手术加辅助治疗，2%（n = 9）接受其他治疗。未接受治疗、单用他莫昔芬、乳房切除术和保乳手术加辅助治疗的女性的5年特异性乳腺癌生存率分别为46%、51%、82%和90%。与未治疗组相比，乳腺癌死亡率的校正风险比为0.4（95% CI，0.2 - 0.7），他莫昔芬单药，0.4（95% CI，0.1 - 1.4）对于单独的保乳手术，0.2（95%CI，0.1 ~ 0.7），保乳手术加辅助治疗为0.1（95%CI，0.03 ~ 0.4）。结论：半数老年乳腺癌患者治疗不足，特异性生存率明显下降。治疗需要适应患者的健康状况，但也应该提供最佳的治愈机会。(C)2003年，美国临床肿瘤学会。
Purpose: No consensus exists on therapy of elderly cancer patients. Treatments are influenced by unclear standards and are usually less aggressive. This study aims to evaluate determinants and effect of treatment choice on breast cancer prognosis among elderly patients.Patients and Methods: We reviewed clinical files of 407 breast cancer patients aged greater than or equal to 80 years recorded at the Geneva Cancer Registry between 1989 and 1999. Patient and tumor characteristics, general health status, comorbidity, treatment, and cause of death were considered. We evaluated determinants of treatment by logistic regression and effect of treatment an mortality by Cox model, accounting for prognostic factors.Results: Age was independently linked to the type of treatment. Overall, 12% of women (n = 48) had no treatment, 32% (n = 132) received tamoxifen only, 7% (n = 28) had breast-conserving surgery only, 33% (n = 133) had mastectomy, 14% (n = 57) had breast-conserving surgery plus adjuvant therapy, and 2% (n = 9) received miscellaneous treatments. Five-year specific breast cancer survival was 46%, 51%, 82%, and 90% for women with no treatment, tamoxifen alone, mastectomy, and breast-conserving surgery plus adjuvant treatment, respectively. Compared with the nontreated group, the adjusted hazard ratio of breast cancer mortality was 0.4 (95% CI, 0.2 to 0.7) for tamoxifen alone, 0.4 (95% CI, 0.1 to 1.4) for breast-conserving surgery alone, 0.2 (95% CI, 0.1 to 0.7) for mastectomy, and 0.1 (95% CI, 0.03 to 0.4) for breast-conserving surgery Plus adjuvant treatment.Conclusion: Half of elderly patients with breast cancer are undertreated, with strongly decreased specific survival as a consequence. Treatments need to be adapted to the patient's health status, but also should offer the best chance of cure. (C) 2003 by American Society of Clinical Oncology.