【原】手术可以改善超高龄老年早期乳腺癌亚洲人群患者生存

　　对于乳腺癌超高龄（年龄≥80岁）老年患者的最佳治疗方案仍有争议。随着人口老龄化，该人群患者的管理将越来越普遍。

　　2017年9月22日，欧洲乳腺癌专科学会《乳腺》在线发表新加坡中央医院、新加坡健康促进局全国疾病登记处、新保集团杜克国大乳腺中心、新加坡国立癌症中心的研究报告，比较了≥80岁患者与<80岁患者对于各分期不同治疗方式的生存结局，并调查了不同分期治疗方式的差异。

　　该研究从新加坡癌症登记处数据库找出2003年1月～2014年12月诊断为乳腺癌的女性新加坡公民和永久居民，将患者分为2个年龄组：<80岁、≥80岁，并将治疗分为3组：手术、非手术治疗、未治疗，对其生存结局进行分析。

　　结果，12年研究期间：

• 共有1万9314例患者诊断为乳腺癌，其中1482例患者分期未知而被剔除。

• 673例患者年龄≥80岁，1万7159例年龄<80岁。

• 对于年龄≥80岁患者，晚期较多，手术可能性较小。

• 对于I～II期患者，2个年龄组手术后5年总生存和乳腺癌相关生存相似。

• 对于年龄≥80岁患者，手术（与未手术和未治疗相比）可使生存改善。

• 对于未手术患者，内分泌治疗优于未治疗。

　　因此，≥80岁患者与<80岁患者相比，尤其对于I～II期乳腺癌，手术结局并不逊色，如果合适，应该进行手术。

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• 根据预期寿命使用乳腺摄片监测老年乳腺癌生存者

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Breast. 2017 Sep 22;36:44-48. [Epub ahead of print]

Surgery for early breast cancer in the extremely elderly leads to improved outcomes - An Asian population study.

Chee Meng Lee, Huili Zheng, Veronique Kiak-Mien Tan, Tira Jing-Ying Tan, Ravindran Kanesvaran, Fuh-Yong Wong, Yi Rong Sim, Wei Sean Yong, Preetha Madhukumar, Kong Wee Ong, Benita Kiat-Tee Tan.

Department of General Surgery, Academia, Singapore; National Registry of Diseases Office, Health Promotion Board, Singapore; Singhealth-Duke NUS Breast Centre, Academia, Singapore; National Cancer Centre Singapore, Singapore.

Highlights

• Elderly patients presented with later stages of disease.

• Elderly patients were likely to be treated less aggressively.

• In early stage breast cancer, surgical treatment afforded similar 5-year survival in both the elderly and the young.

• Among the elderly, surgery resulted in improved survival, compared to those with non-surgical treatment and no treatment.

• Those who did not have surgery performed better with endocrine therapy than with no treatment.

AIM: The optimal treatment of breast cancer for extremely elderly patients (aged ≥ 80 years) is debatable. With an aging population, management of this group of patients will be increasingly common. This study aims to compare the survival outcomes of extremely elderly patients against younger ones, following different treatment modalities within each stage. The differences in treatment patterns across different stages have also been examined.

METHODS: Female Singapore Citizens and Permanent Residents diagnosed with breast cancer from 2003 to 2014 were identified from the Singapore Cancer Registry. Patients were divided into 2 age groups, below 80, and 80 and above years old, and categorized into 3 main treatment groups, namely surgery, non-surgical treatment, and no treatment. Analysis was made on their survival outcomes.

RESULTS: 19,314 patients were diagnosed with breast cancer during the 12-year study period. 1482 patients were excluded due to unknown stage. 673 patients were aged 80 years and above, while 17,159 patients were aged below 80. Elderly patients presented with later stages of disease, and were less likely to have surgery. In Stage I and II, the difference in 5-year breast cancer specific outcome following surgery, was small between the 2 age groups. Among the elderly group, surgery resulted in improved survival. Those who did not have surgery performed better with endocrine therapy than with no treatment.

CONCLUSIONS: Extremely elderly patients, especially those with Stages I and II breast cancer do not fare worse than younger patients, and should be offered surgery if they are fit.

KEYWORDS: Extremely elderly; Treatment; Surgery; Outcome; Survival; ≥ 80 years

DOI: 10.1016/j.breast.2017.09.002