老年早期三阴性乳腺癌术后化疗生存率
三阴性乳腺癌与其他乳腺癌相比，对内分泌治疗和HER2靶向治疗效果不佳，术后全身治疗局限于化疗。由于死亡风险和合并症的相互影响，虽然三阴性乳腺癌老年患者术后化疗比例不断提高，但是前瞻临床研究极少，故有必要对历史数据进行回顾分析。不过，回顾分析难以避免选择偏倚，例如选择化疗的患者通常年轻、合并症较少、肿瘤较大、分级较高、淋巴结转移较多，选择不化疗的患者通常高龄、合并症较多、肿瘤较小、分级较低、淋巴结转移较多。
2020年11月30日，英国《柳叶刀》健康长寿分册在线发表瑞典哥德堡大学萨赫尔格雷斯卡医院、瑞典西部地区癌症中心、美国佛罗里达MD安德森癌症中心的研究报告，探讨了术后化疗对早期三阴性乳腺癌老年女性生存结局的影响，以提供有助此类患者治疗决策的信息。
该大样本回顾研究利用瑞典全国乳腺癌登记数据库、瑞典患者登记数据库、瑞典死亡原因登记数据库，对2009年1月1日～2016年12月31日进行手术治疗的年龄≥70岁原发早期三阴性乳腺癌（直径大于5毫米且无远处转移）女性患者进行回顾分析。剔除雌激素受体、孕激素受体或HER2状态、乳房手术方法或化疗数据不全的患者。通过倾向评分匹配模型，并对年龄、肿瘤大小、肿瘤分级、淋巴结状态、合并症评分等其他影响因素进行校正，分析术后化疗对5年乳腺癌相关生存和5年总生存结局的影响。
结果，共计1130例三阴性乳腺癌女性符合分析条件，其中：
术后化疗：368例（32.6%）
术前化疗：45例（4.0%）
未化疗：717例（63.5%）
术后化疗与未化疗的患者相比：
5年乳腺癌相关生存率显著较高：68%比55%（95%置信区间：64～72、81～89，P<0.0001）
5年总生存率也显著较高：79%比49%（95%置信区间：75～84、45～53，P<0.0001）
根据倾向评分匹配分析，术后化疗与未化疗的匹配患者相比：
5年乳腺癌相关生存率显著较高：83%比73%（95%置信区间：78～89、67～80，P=0.014）
5年总生存率也显著较高：75%比63%（95%置信区间：69～82、57～71，P=0.029）
因此，该研究结果表明，对于年龄≥70岁的早期三阴性乳腺癌女性，术后化疗与未化疗的患者相比，5年乳腺癌相关生存率和5年总生存率都显著较高，即使年龄和合并症评分相似。这些结果强调对老年患者考虑术后化疗的重要性。
对此，意大利米兰大学欧洲癌症研究院发表同期评论：早期三阴性乳腺癌老年患者化疗的用途。
Lancet Healthy Longevity. 2020 Nov 30. Online ahead of print.
Adjuvant chemotherapy and survival in women aged 70 years and older with triple-negative breast cancer: a Swedish population-based propensity score-matched analysis.
Slavica Janeva, Chenyang Zhang, Anikó Kovács, Toshima Z Parris, Jennifer A Crozier, Christopher M Pezzi, Barbro Linderholm, Riccardo A Audisio, Roger Olofsson Bagge.
Sahlgrenska University Hospital, Gothenburg, Sweden; University of Gothenburg, Gothenburg, Sweden; Regional Cancer Center Western Sweden, Gothenburg, Sweden; Baptist MD Anderson Cancer Center, Jacksonville, FL, USA.
BACKGROUND: Triple-negative breast cancer (TNBC) is an aggressive form of breast cancer associated with poor survival, in which adjuvant systemic treatments are limited to chemotherapy. Due to competing mortality risks and comorbidities, older patients with TNBC are often undertreated with adjuvant chemotherapy, and clinical trials on this problem are scarce, despite a growing patient population. This study aimed to assess outcomes for patients aged 70 years and older with TNBC with or without chemotherapy in a national population-based registry, to provide information that can assist in treatment decisions for these patients.
METHODS: In this population-based registry study, data on all patients aged 70 years and older diagnosed with primary early TNBC (larger than 5 mm in diameter and without distant metastasis) and surgically treated between Jan 1, 2009, and Dec 31, 2016, were retrieved from the Swedish National Breast Cancer Register, the Swedish Patient Register, and the Swedish Cause of Death Register. Patients with incomplete data (on oestrogen receptor, progesterone receptor, or human epidermal growth factor receptor 2 status, surgical procedure in the breast, or information about chemotherapy) were excluded. A propensity score-matched (PSM) model was used to examine the outcomes of adjuvant chemotherapy on 5-year breast cancer-specific survival (BCSS) and 5-year overall survival (OS), adjusted for age, tumour size, tumour grade, nodal status, and comorbidities.
FINDINGS: Of 1130 women eligible for analysis, 368 (32.6%) received adjuvant chemotherapy, 45 (4.0%) received neoadjuvant treatment, and 717 (63.5%) did not receive chemotherapy. 5-year BCSS was significantly improved in patients who received adjuvant chemotherapy (85% [95% CI 81-89]) compared with patients who did not receive chemotherapy (68% [64-72]; p<0.0001). A similar benefit was observed in 5-year OS (79% [95% CI 75-84] vs 49% [45-53]; p<0.0001). In our PSM analysis, 5-year BCSS in patients treated with adjuvant chemotherapy was 83% (95% CI 78-89), versus 73% (67-80; p=0.014) in patients not treated with chemotherapy. 5-year OS in patients treated with adjuvant chemotherapy was 75% (95% CI 69-82), versus 63% (57-71; p=0.029) in patients who did not receive chemotherapy.
INTERPRETATION: In this PSM registry analysis of surgically treated female patients aged 70 years and older with TNBC without distant metastasis, we identified a significant benefit both in 5-year BCSS and 5-year OS with adjuvant chemotherapy versus no chemotherapy, which persisted when adjusting for age and comorbidities. These results underline the importance of considering adjuvant chemotherapy in older patients.
FUNDING: Knut and Alice Wallenberg Foundation, Assar Gabrielsson Foundation
DOI: 10.1016/S2666-7568(20)30018-0
Lancet Oncol. 2020 Dec;21(12):1543-1545.
Use of chemotherapy in elderly patients with early-stage triple-negative breast cancer.
Giuseppe Curigliano, Gabriella Pravettoni.
European Institute of Oncology, IRCCS, Milan, Italy; University of Milan, Milan, Italy.
DOI: 10.1016/S1470-2045(20)30694-X