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中国乳腺癌的年龄构成正向老年群体转变，确诊时中位年龄不断增加。大约30%的中国乳腺癌患者年龄≥60岁，占全部死亡病例的46%。2015年，31.30%的乳腺癌患者年龄≥60岁；到2030年，该年龄组乳腺癌新发病例比例预计将达41.37%。60岁以上患者与年轻患者相比，乳腺癌死亡率显著较高，这表明老年女性可能对乳腺癌诊断和治疗的进步获益较少。因此，对年轻与老年患者不同治疗模式的研究将有助于我们确定导致死亡率差异的因素并制定消除这些差异的策略。 2022年9月6日，欧洲乳腺癌专科医师学会《乳腺》在线发表复旦大学附属肿瘤医院桑雨婷、杨犇龙、莫淼、刘诗洋、周旭婕、陈嘉健、郝爽、黄晓燕、柳光宇、邵志敏、吴炅等学者的研究报告，根据目前治疗策略对老年与年轻乳腺癌患者的临床病理特征和生存结局进行了比较。 该单中心回顾研究将2008年1月～2016年12月在复旦大学附属肿瘤医院确诊为单侧原发乳腺浸润癌的女性患者分为年轻组（<65岁）和老年组（≥65岁）并且通过倾向评分匹配对两组患者的临床病理特征进行平衡。 结果，共计1万3707例单侧原发乳腺浸润癌女性患者资料完整且接受过治疗但未接受新辅助治疗，其中年轻患者1万2004例、老年患者1703例。
- 腋窝淋巴结清扫比例较高（48.96%比46.21%）
中位随访68.12个月，通过倾向评分匹配，临床病理特征完全匹配的1044例老年患者与1044例年轻患者相比，总死亡风险高216%（风险比：2.16，95%置信区间：1.60～2.92，P<0.001）。
辅助化疗与老年患者总生存独立相关，辅助化疗与未辅助化疗相比：- 通过多因素比例风险回归模型对其他影响因素进行校正后，老年患者总死亡风险低31%（风险比：0.69，P=0.039）
- 通过倾向评分匹配对其他影响因素进行平衡后，老年患者匹配队列的总死亡风险低42%（风险比：0.58，P=0.041）
亚组分析表明，老年患者辅助化疗生存获益的显著影响因素包括：- 淋巴结转移较多（风险比：0.44，P=0.040）
因此，该研究结果表明，老年乳腺癌患者侵袭性临床病理学特征较少、手术强度较高、用药强度较弱。对于老年患者，应该考虑加用辅助化疗，尤其对于肿瘤较大、淋巴结转移较多的患者。Breast. 2022 Sep 6. Online ahead of print.Treatment and survival outcomes in older women with primary breast cancer: A retrospective propensity score-matched analysis.Yuting Sang, Benlong Yang, Miao Mo, Shiyang Liu, Xujie Zhou, Jiajian Chen, Shuang Hao, Xiaoyan Huang, Guangyu Liu, Zhimin Shao, Jiong Wu.Fudan University Shanghai Cancer Center, Shanghai, China; Fudan University Shanghai Medical College, Shanghai, China.- Older breast cancer patients showed less aggressive clinicopathological features.
- The majority of older patients received aggressive surgery in current practice.
- Less than half of older breast cancer patients received adjuvant chemotherapy.
- Older breast cancer patients could benefit from adjuvant chemotherapy.
PURPOSE: Changes in biological features and functional status make management decisions in older women with primary breast cancer complicated. We aimed to provide an overview of the clinicopathological characteristics and survival outcomes of older breast cancer patients based on the current treatment strategies.METHODS: Female patients diagnosed with primary invasive breast cancer at Fudan University Shanghai Cancer Centre from 2008-2016 were included. Patients were divided into a younger group (<65 years) and older group (≥65 years). Propensity score matching was utilised to generate balanced cohorts.RESULTS: A total of 13,707 patients met the study criteria. Compared with younger patients, older patients had a higher Charlson Comorbidity Index (p<0.001), less lymph node metastasis (p=0.009), more advanced tumour stage (p=0.038), and a larger proportion of estrogen receptor-positive (p<0.001) and epidermal growth factor receptor 2-negative (p<0.001) tumours. Older patients were likely to receive mastectomy and axillary lymph node dissection in addition to a lower proportion of adjuvant chemotherapy. Adjuvant chemotherapy (HR [hazard ratio] 0.69, p=0.039) was independently correlated with better overall survival in the older patients. This survival benefit (HR 0.58, p=0.041) was confirmed in matched cohorts. Among the older patients with larger tumours (HR 0.48, p=0.038) and more lymph node involvement (HR 0.44, p=0.040), adjuvant chemotherapy was associated with a significant survival benefit.CONCLUSION: Older breast cancer patients showed less aggressive biological characteristics, intensive surgical and moderate medical preferences. The addition of adjuvant chemotherapy should be considered for older patients, especially for patients with large tumours and more lymph node involvement.KEYWORDS: Breast cancer, Older women, Treatment strategy, Clinicopathological features, Survival outcomesDOI: 10.1016/j.breast.2022.09.001
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