AGE-RELATED DIFFERENCES IN BREAST-CANCER-TREATMENT
AGE-RELATED DIFFERENCES IN BREAST-CANCER-TREATMENT
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DOI：
10.1007/bf02303540
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发表时间：
1994-01-01
影响因子：
3.7
通讯作者：
SONDAK, VK
中科院分区：
文献类型：
--
作者：
AUGUST, DA;REA, T;SONDAK, VK
背景：在美国接受治疗的乳腺癌病例中，超过一半发生在65岁以上的女性中。这项研究调查了乳腺癌治疗中年龄相关的差异。方法：对所有在密歇根大学乳腺护理中心接受30个月治疗的原发性可手术浸润性乳腺癌的女性进行回顾性研究，共发现77例年龄大于或等于65岁的老年患者（中位71岁，最老患者92岁），这些患者的合并症、肿瘤分期和组织学、手术、放疗、化学激素治疗和并发症的详细信息。51例年龄55-64岁的年轻患者（中位数59）被确定用于比较。患者分为接受标准治疗和非标准治疗两组。标准治疗的前瞻性定义如下：局部/区域乳房肿瘤切除术和腋窝淋巴结清扫加放疗或改良根治性乳房切除术；II期疾病的全身化疗和/或他莫昔芬。为每位患者计算的合并症评分为养老院居住，非活动状态，最近手术和需要药物治疗的每个医疗问题各分配一分。结果：当评估整体治疗（局部/区域加全身）时，接受标准治疗的老年患者比例较少（77例中55例对51例中47例；p < 0.01）。接受包括腋窝清扫的手术治疗的老年患者少于年轻患者（77例中62例对51例中50例；p < 0.01）。较小比例的老年患者在乳房肿瘤切除术和腋窝淋巴结清扫后接受放射治疗（29例中26例对19例；N.S.）。总体而言，77例老年患者中只有59例接受了标准的局部/区域护理，51例年轻患者中只有50例（p < 0.001）。年轻和老年患者接受II期乳腺癌标准全身治疗的比例相似（22 / 19和30 / 24），但老年患者接受化疗的可能性低于年轻患者（7%对50%；p < 0.001）。治疗相关并发症与年龄无关，但接受标准治疗的患者比接受非标准治疗的患者更常见（102例中45例对26例中2例；p < 0.001）。合并症评分与非标准治疗的使用相关，而与年龄无关。接受总体标准治疗的老年和年轻患者的得分分别为0.8，而接受非标准治疗的患者的得分分别为1.5和1.4。有趣的是，对偏离标准治疗指南的决定的解释往往没有被确定。在接受非标准治疗的四名年轻患者中，只有一名明确指出了合并症。在22例接受非标准治疗的老年患者中，共患病8例，年龄6例，患者选择4例。随访（中位34个月）未显示无病或总生存差异与年龄或治疗有关（标准与非标准）。
Background: More than half of the cases of breast cancer treated in the United States occur in women over age 65. This study investigates age-related differences in breast cancer therapy.Methods: A retrospective review of all women with primary operable invasive breast cancer treated at the University of Michigan Breast Care Center over a 30-month period showed a total of 77 older patients aged greater-than-or-equal-to 65 years (median, 71; oldest patient, 92) for whom full information was available regarding comorbidity, tumor stage and histology, and details of surgery, radiation, and chemohormonal therapy and complications. Fifty-one similar younger patients aged 55-64 years (median, 59) were identified for comparison. Patients were classified as either having received standard treatment or nonstandard treatment. Standard therapy was prospectively defined as follows: local/regional-lumpectomy and axillary lymph node dissection plus radiation therapy or modified radical mastectomy; systemic-chemotherapy and/or tamoxifen for stage II disease. A comorbidity score calculated for each patient assigned one point each for nursing home residence, nonambulatory status, recent surgery, and each medical problem requiring drug therapy.Results: When overall treatment (local/regional plus systemic) was assessed, proportionately fewer older patients (55 of 77 versus 47 of 51; p < 0.01) received standard treatment. Fewer older than younger patients (62 of 77 versus 50 of 51; p < 0.01) received surgical therapy that included an axillary dissection. A smaller proportion of older patients received radiation therapy following lumpectomy and axillary lymph node dissection (26 of 29 versus 19 of 19; N.S.). Overall, only 59 of 77 older patients versus 50 of 51 younger patients (p < 0.001) received standard local/regional care. Similar proportion of younger and older patients (19 of 22 and 24 of 30, respectively) received standard systemic therapy for stage II breast cancer, but older patients were less likely to receive chemotherapy than younger patients (7% versus 50%; p < 0.001). Treatment-related complications were not age-related but were more frequent in patients receiving standard treatment than in patients receiving nonstandard treatment (45 of 102 versus two of 26; p < 0.001). Comorbidity score correlated with the use of nonstandard therapy but not with age. The scores for both older and younger patients receiving overall standard treatment were 0.8 versus 1.5 and 1.4, respectively, in patients receiving nonstandard treatment. Interestingly, explanations for decisions to deviate from standard treatment guidelines were often not identified. Comorbidity was explicitly noted in only one of four younger patients who received nonstandard treatment therapy. In 22 older patients who received nonstandard treatment, comorbidity was cited in eight cases, patient age was cited in six cases, and patient choice was cited in four cases. Follow-up (median, 34 months) did not show that disease-free or overall survival differences were related to age or to treatment (standard versus nonstandard).